Blood Pressure Control and Antihypertensive Drugs in ALLHAT Trial Participants and the Risk of Alzheimers Disease and Related dementias

ALLHAT 试验参与者的血压控制和抗高血压药物以及阿尔茨海默病和相关痴呆的风险

• 批准号: 10121251
• 负责人: XIANGLIN DU
• 金额: $ 29.92万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10121251
• 关键词: Address; Administrative Supplement; Adrenergic alpha-Antagonists; Adult; Adverse event; Affect; Age-associated memory impairment; Alzheimer' s Disease; Alzheimer' s disease related dementia; Alzheimer' s disease risk; American; Amlodipine; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Calcium Channel Blockers; Cardiovascular Diseases; Cessation of life; Chlorthalidone; Chronic Disease; Clinical Treatment; Cognition; Confidence Intervals; Coronary heart disease; Data; Dementia; Disease; Disease Outcome; Diuretics; Double-Blind Method; Doxazosin; Elderly; End stage renal failure; Event; Follow-Up Studies; Goals; Heart failure; High Prevalence; Hip Fractures; Hypertension; Impaired cognition; Incidence; Intervention Trial; Link; Lipids; Lisinopril; Longterm Follow-up; Malignant Neoplasms; Marketing; Medicare; Medicare claim; Memory; Mental Depression; Monitor; Myocardial Infarction; Participant; Patients; Persons; Pharmaceutical Preparations; Pharmacotherapy; Pharmacy facility; Population; Prevention strategy; Randomized; Randomized Clinical Trials; Recommendation; Recording of previous events; Reporting; Risk; Risk Factors; Stroke; Stroke prevention; Time; United States Centers for Medicare and Medicaid Services; United States Food and Drug Administration; aged; arm; base; blood pressure intervention; blood pressure regulation; comorbidity; follow-up; hazard; heart disease risk; mild cognitive impairment; mortality; mortality risk; parent grant; pelvis fracture; prevent; primary outcome; public health relevance; recruit; secondary outcome; side effect; thiazide; treatment arm

Abstract The focus of the active parent grant (Long-term Benefits & Harms of Antihypertensive Drugs in the Elderly: Up to 22-year Follow-Up of ALLHAT Trial Participants) is to determine if there are any long-term benefits for the reduced risk of coronary heart disease (CHD), cardiovascular disease (CVD), stroke, and mortality in those receiving diuretics as compared to those receiving other antihypertensive drugs into next 15-year post-trial surveillance period after taking into consideration post-trial antihypertensive medication usage from Medicare Part-D pharmacy data; and if long-term side effects, such as cancer and depression which are identifiable from post-marketing surveillance of Medicare claims, are similar among the 3 arms of antihypertensive drugs. The goal will be achieved by linking the data of ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) participants with their Medicare data up to 2017, making the total follow-up time up to 23 years (including 8-year in-trial and 15-year post-trial follow-up). Antihypertensive drug therapies have recently been associated with a lower risk of developing dementia and early cognitive impairment. For example, in 2019 the Systolic Blood Pressure Intervention Trial (SPRINT) Memory and Cognition in Decreased Hypertension (MIND) study reported that intensive blood pressure (BP) control significantly reduced the risk of mild cognitive impairment. This was the first trial to demonstrate an effective strategy for the prevention of age-related cognitive impairment. Given a high prevalence of hypertension in adult population, adequate utilization of disease- modifying drugs may provide an effective strategy for prevention of Alzheimer’s disease (AD) and related dementias (ADRD). However, there is no large and long-term follow-up study monitoring and assessing the effects of antihypertensive medications on the risk of ADRD. Therefore, with the detailed blood pressure control data available during the trial follow-up in ALLHAT participants and with the data of those participants linked with their Medicare Part-D drug data up to 2017, we will be able to determine whether blood pressure control and antihypertensive drugs are associated with the decreased risk of ADRD during the 23 years of follow-up from 1994 to 2017. We will address the following specific aims in this Alzheimers-focused Administrative Supplement: 1) to determine the risk of ADRD in association with blood pressure control and antihypertensive treatments (diuretics, ACE inhibitors, and calcium channel blockers) in ALLHAT participants; and 2) to examine whether and to what extent the post-trial antihypertensive medication usage from Medicare Part-D data affect the risk of ADRD in ALLHAT participants with 3 trial treatment arms (diuretics, ACE inhibitors, and calcium channel blockers), while taking into consideration death as a competing risk and adjusting for comorbid conditions and other confounders.

抽象的 活跃的父母赠款的重点（老年人中降压药的长期福利和危害：UP 到22年的allhat试验参与者的随访）是确定是否有任何长期利益 降低冠心病的风险（CHD），心血管疾病（CVD），中风和死亡率 与接受其他降压药的人相比，接受利尿剂与下一个15年的审判 在考虑了Medicare的监测后降压药物使用后的监视期 部分D药房数据；如果长期副作用（例如癌症和抑郁症）可以从 在降压药的三个臂中，医疗保险索赔的上市后监视相似。这 将通过链接allhat的数据（降压和降低脂质处理以防止）来实现目标 心脏病发作试验）参与者截至2017年，其医疗保险数据的总后续时间长达23年 （包括8年期间和15年后随访）。降压药疗法最近 与患痴呆症和早期认知障碍的风险较低有关。例如，在2019年 收缩压干预试验（SPRINT）记忆和高血压降低（思维）的认知 研究报告说，强化血压（BP）控制大大降低了轻度认知的风险 损害。这是第一个证明预防与年龄相关的认知的有效策略的试验 损害。考虑到成年人口中高血压的高度患病率，疾病的充分利用 修改药物可以为预防阿尔茨海默氏病（AD）及相关的有效策略提供有效的策略 痴呆症（ADRD）。但是，没有大型和长期的随访研究监测和评估 降压药对ADRD风险的影响。因此，通过详细的血压控制 在Allhat参与者的试验后续审判期间可用的数据以及与这些参与者的数据相关联的数据 他们的Medicare Part-D药物数据截至2017年，我们将能够确定血压控制和 在23年的随访中，降压药与ADRD风险下降有关 1994年至2017年。我们将在以阿尔茨海默氏症为中心的行政补品中解决以下具体目标： 1）确定与血压控制和降压治疗相关的ADRD风险 （利尿剂，ACE抑制剂和钙通道阻滞剂）在Allhat参与者中； 2）检查是否 Medicare Part D数据在多大程度上审判后的降压药物使用了 ADRD在Allhat参与者中具有3个试验臂（利尿剂，ACE抑制剂和钙通道） 封锁者），同时考虑死亡是一种竞争风险，并调整了合并症条件和 其他混淆者。