Home blood pressure and falls among older adults

老年人的家庭血压和跌倒情况

• 批准号: 10403687
• 负责人: Emily B Levitan
• 金额: $ 38.29万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-15 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10403687
• 关键词: Adult; Age-Years; Ambulatory Blood Pressure Monitoring; Ancillary Study; Antihypertensive Agents; Blood Pressure; Blood Pressure Monitors; California; Cardiovascular Diseases; Cardiovascular system; Cause of Death; Cessation of life; Characteristics; Clinic; Clinical; Data; Elderly; Electronic Health Record; Enrollment; Environment; Equilibrium; Event; Funding; Geriatric Assessment; Goals; Gold; Guidelines; Health Personnel; Health system; Healthcare; Home; Home Blood Pressure Monitoring; Hospitalization; Hour; Hypertension; Individual; Injury; Inpatients; Knowledge; Measurement; Measures; Outpatients; Participant; Patients; Persons; Pharmaceutical Preparations; Predictive Value; Procedures; Prospective cohort study; Public Health; Randomized Controlled Trials; Research; Rest; Risk; Risk Reduction; Role; Techniques; Time; United States National Institutes of Health; Visit; base; blood pressure control; blood pressure variability; cardiovascular disorder risk; cardiovascular risk factor; clinical practice; cost; cost efficient; design; experience; fall injury; fall risk; falls; follow-up; high risk; human old age (65+); improved; personalized care; predict clinical outcome; prognostic; routine care

Cardiovascular disease (CVD) is the leading cause of death among older US adults. Over 75% of US adults ≥ 65 years of age have hypertension, a major risk factor for CVD. Randomized controlled trials have demonstrated that lowering blood pressure (BP) through antihypertensive medication reduces the risk for CVD by 20% to 40% among older adults with hypertension. Many older US adults have uncontrolled BP and may receive CVD risk reduction benefits from intensifying their antihypertensive medication. However, clinicians are often concerned that intensively lowering BP may increase the risk for a fall. Falls are the leading cause of injury-related hospitalization and death among older US adults and more than one in three US adults ≥ 65 years of age experience a fall each year. BP has traditionally been measured in the clinic setting and a major challenge that clinicians encounter in deciding to titrate antihypertensive medication is the inaccuracy of BP assessed in this setting. Home blood pressure monitoring (HBPM) is an inexpensive and highly feasible approach to measure BP outside of the clinic setting and has the potential to improve BP control and, therefore, reduce CVD risk. Whether HBPM can identify patients for whom antihypertensive medication can be intensified without increasing the risk for a fall is unknown. A newly NIH-funded (July 1, 2018 to June 30, 2022) prospective cohort study (AMBulatoRy blOod preSsure In older Adults [AMBROSIA]) will evaluate the association of BP, measured outside of the clinic setting using ambulatory blood pressure monitoring (ABPM), with falls risk among 1,057 adults aged ≥ 65 years, taking antihypertensive medication from the Kaiser Permanente Southern California (KPSC) health system. ABPM was chosen for the AMBROSIA study as it is considered the gold-standard approach for assessing out-of-clinic BP. Compared to ABPM, HBPM is more widely available in the US and better tolerated by patients. The AMBROSIA study is not funded to perform HBPM. The overall goal of the proposed ancillary study to AMBROSIA is to determine whether BP on HBPM can identify older adults taking antihypertensive medication who are at increased risk for falls, and whether HBPM provides similar predictive value for falls when compared with ABPM. AMBROSIA will begin study visits in February 2019 and the proposed ancillary study (AMBROSIA-HOME) will add the conduct of HBPM for 7 days, with two BP measurements obtained in the morning and two BP measurements obtained in the evening on each day, following the conduct of ABPM for 1,000 participants. Conducting the AMBROSIA-HOME study will be cost-efficient as information on demographic and clinical characteristics, geriatric assessments, research-grade BP measurements, and 24-hour ABPM is already being collected at baseline with falls and serious fall injuries being assessed during a one-year follow-up period. The AMBROSIA-HOME study will provide valuable data on the role of HBPM to personalize care for older adults taking antihypertensive medication.

心血管疾病（CVD）是美国老年人死亡的主要原因。超过75％的美国成年人≥ 65岁的人患有高血压，这是CVD的主要危险因素。随机对照试验具有 证明通过降压药降低血压（BP）可降低CVD的风险 高血压老年人中的20％至40％。许多美国年龄较大的成年人的BP不受控制，可能 通过加强其降压药物来获得CVD降低风险的收益。但是，临床医生 通常担心强烈降低BP可能会增加跌倒的风险。瀑布是主要原因 美国老年人与伤害有关的住院和死亡，三分之一的美国成年人≥65 年龄经验每年跌倒。传统上，BP是在诊所环境中测量的，并且是主要的 临床医生在决定滴定降压药物时遇到的挑战是BP的不准确性 在此环境中进行评估。家庭血压监测（HBPM）是便宜且高度可行的 测量诊所环境外BP的方法，并有可能改善BP控制和 因此，降低CVD风险。 HBPM是否可以识别可以为之降级药物的患者 加强而没有增加跌倒风险的情况是未知的。 NIH资助的新资金（2018年7月1日至2022年6月30日） 前瞻性队列研究（老年人的门诊血压[Ambrosia]）将评估 BP的关联，使用卧床血压监测（ABPM）在诊所设置之外测量， 在1,057名年龄≥65岁的成年人中有跌倒风险，从Kaiser服用抗高血压药物 Permanente南加州（KPSC）卫生系统。 ABPM被选为Ambrosia研究，因为它是 被认为是评估临床外BP的金标准方法。与ABPM相比，HBPM更多 在美国广泛使用，患者可以更好地耐受。 Ambrosia研究没有资助 HBPM。拟议的辅助研究对Ambrosia的总体目标是确定BP是否在HBPM上 可以识别服用降低跌倒风险的降压药的老年人，以及是否存在 与ABPM相比，HBPM为跌倒提供了相似的预测值。 Ambrosia将开始学习 2019年2月和拟议的辅助研究（Ambrosia-Home）将增加HBPM的行为7 天数，在早晨获得了两个BP测量，并在晚上获得了两个BP测量 每天，在1,000名参与者的ABPM进行之后。进行Ambrosia-home研究 作为有关人口统计和临床特征，老年评估的信息，将是成本效益的， 研究级BP测量和24小时ABPM已经在基线时随着瀑布和 在一年的随访期间评估严重的秋季伤害。 Ambrosia-Home研究将 提供有关HBPM在为老年人个性化护理中的作用的宝贵数据 药物。