Improving Blood Pressure Screening and Treatment Strategies in Young Adults

改善年轻人的血压筛查和治疗策略

基本信息

批准号：
10645006
负责人：
Jaejin An
金额：
$ 68.85万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-07-01 至 2026-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10645006
关键词：
Address Adverse event African American Age Antihypertensive Agents Blood Pressure California Cardiovascular Diseases Characteristics Chronic Kidney Failure Clinical Coronary heart disease Data Databases Diabetes Mellitus Disease Outcome Early Diagnosis Early treatment Elderly Electronic Health Record Epidemiology Event Future Goals Guidelines Health Heart failure High Prevalence Hypertension Intervention Kidney Left Life Microalbuminuria Myocardial Infarction Obesity Observational Study Organ Outcome Overweight Patients Pharmaceutical Preparations Policy Maker Population Prevalence Productivity Quality of life Race Randomized, Controlled Trials Recommendation Research Priority Risk Risk Factors Risk Reduction Selection Bias Statistical Models Stroke Subgroup Syncope Time United States Preventative Services Task Force aged blood pressure control blood pressure elevation cardiovascular disorder risk cardiovascular health cardiovascular risk factor clinically actionable clinically relevant cohort cost cost effective cost efficient early onset economic impact evidence base follow-up health inequalities healthy aging high risk high risk population hypertension treatment improved pharmacologic premature prevent screening screening guidelines simulation social health determinants treatment risk treatment strategy young adult

项目摘要

Project Summary The overall reduction in the rate of cardiovascular disease (CVD) over the past decades in the US has not extended to young adults aged 18-39 years. An increasing prevalence of CVD risk factors in young adults, including high blood pressure (BP), likely contributed to the increase in CVD rates. About 20% of US young adults have stage 1 or 2 hypertension (BP 130-139/80-89 mm Hg and ≥140/90 mm Hg, respectively). Despite the high prevalence of hypertension in young adults and its association with CVD, there is little evidence to guide BP screening and treatment recommendations in young adults. For BP screening, >25% of young adults in the US with hypertension are unaware that they have it. Moreover, social determinants of health (SDOH), an important influence on the health of young adults, is not considered in BP screening recommendations. For BP management, the benefits of initiating antihypertensive medications during young adulthood are unknown and are extrapolated from data among older adults. Due to the lack of evidence, most of the 13 million young adults with stage 1 hypertension are currently not recommended to initiate antihypertensive medication, and 50% (2.5 million) of young adults with stage 2 hypertension are currently left untreated. Although randomized controlled trials (RCTs) with hard CVD outcomes will provide definitive evidence, it may not be feasible to perform such a trial in young adults due to high costs and long follow-up time needed to determine CVD risk reduction benefits. In the absence of RCTs, high quality observational and simulation studies can provide clinically relevant and actionable evidence for policy makers, patients, and clinicians in a cost-efficient manner. The overall study objectives are to determine the optimal BP screening intervals for young adults and to identify those with a high risk of premature and/or lifetime CVD who may benefit from antihypertensive medication during young adulthood. The aims of this study are to (1) determine BP screening intervals by examining the timing of transitioning from normal BP into stage 1 or 2 hypertension and long-term BP trajectories, (2) identify characteristics of young adults with stage 1 or 2 hypertension who are at high risk for adverse CVD or renal outcomes, (3) quantify the benefits and harms of antihypertensive medication among young adults with stage 1 or 2 hypertension by emulating a hypothetical RCT using a large observational database and state-of-the-art statistical models to minimize confounding and selection bias, and (4) compare the short- and long-term health and economic impact of BP screening and management strategies for US young adults identified in Aims 1 to 3 vs. current BP guidelines. To address these aims, we will study ~500,000 young adults aged 18-39 years from both Kaiser Permanente Southern California and four epidemiologic cohorts. Findings from this study will inform future BP guidelines, reduce health inequity by directing screening and treatment to high risk subgroups, and improve cardiovascular health of US young adults.

项目概要过去几十年来，美国心血管疾病（CVD）发病率的总体下降并未扩大到 18-39 岁的年轻人 CVD 危险因素在年轻人中的患病率不断增加，包括高血压 (BP)，可能导致美国约 20% 年轻人的 CVD 发病率上升。成人患有 1 期或 2 期高血压（血压分别为 130-139/80-89 mm Hg 和 ≥140/90 mm Hg）。年轻人高血压患病率较高及其与 CVD 的关系，但几乎没有证据表明指导年轻人的血压筛查和治疗建议对于 25% 以上的年轻人进行血压筛查。在美国，患有高血压的人并不知道自己患有健康的社会决定因素（SDOH）。血压筛查建议中未考虑对年轻人健康的重要影响。管理方面，在成年早期开始服用抗高血压药物的益处尚不清楚，并且由于缺乏证据，1300 万年轻人中的大多数人的数据是根据老年人的数据推断出来的。目前不建议患有 1 期高血压的患者开始服用抗高血压药物，50%（2.5 百万）患有 2 期高血压的年轻人目前尚未得到治疗。具有硬CVD结果的试验（RCT）将提供明确的证据，但进行这样的试验可能不可行由于成本高且需要较长的随访时间来确定 CVD 风险降低，因此在年轻人中进行试验在缺乏随机对照试验的情况下，高质量的观察和模拟研究可以提供临床益处。以具有成本效益的方式为政策制定者、患者和忠诚者提供相关且可操作的证据。总体研究目标是确定年轻人的最佳血压筛查间隔并确定那些具有过早和/或终生心血管疾病高风险的人可能会受益于抗高血压药物本研究的目的是 (1) 通过检查血压筛查间隔来确定。从正常血压转变为 1 期或 2 期高血压的时间以及长期血压轨迹，(2) 确定患有 1 期或 2 期高血压且具有不良 CVD 或肾病风险高风险的年轻人的特征结果，(3) 量化抗高血压药物对 1 期年轻人的益处和危害或 2 高血压，通过使用大型观察数据库和最先进的技术模拟假设的 RCT 统计模型，以尽量减少混杂和选择偏差，以及（4）比较短期和长期健康状况目标 1 至 5 中确定的美国年轻人血压筛查和管理策略的经济影响 3 与当前 BP 指南的比较为了实现这些目标，我们将研究约 500,000 名 18-39 岁的年轻人。来自南加州凯撒医疗机构和四个流行病学队列的研究结果将。为未来的血压指南提供信息，通过针对高风险人群进行筛查和治疗来减少健康不平等亚群体，并改善美国年轻人的心血管健康。

项目成果

期刊论文数量（1）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Fixed-Dose Combination Medication Use Among US Adults With Hypertension: A Missed Opportunity.

美国成人高血压患者使用固定剂量联合用药：错失良机。

DOI：
发表时间：
2023-02-21
期刊：
影响因子：
5.4
作者：
Mobley, Claire M;Bryan, Alexis S;Moran, Andrew E;Derington, Catherine G;Zhang, Yiyi;Bellows, Brandon K
通讯作者：
Bellows, Brandon K