Role and Mechanism of Blood Pressure Variability in Risk of Heart Failure

血压变异在心力衰竭风险中的作用和机制

• 批准号: 10154141
• 负责人: Daniel Sevag Nuyujukian
• 金额: $ 6.64万
• 依托单位: UNIVERSITY OF ARIZONA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-19 至 2024-01-18
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10154141
• 关键词: Accounting; Antihypertensive Agents; Blood Pressure; Cardiac; Cardiovascular Diseases; Cardiovascular system; Characteristics; Clinical; Clinical assessments; Clinical/Radiologic; Communities; Computerized Medical Record; Coronary; Coronary heart disease; Data; Data Sources; Databases; Diabetes Mellitus; Diagnosis; Diastole; Diastolic blood pressure; EFRAC; Epidemiology; Ethnic Origin; Event; Foundations; Future; Healthcare Systems; Heart failure; Image; Injury; Investigation; Ischemia; Lead; Light; Link; Longitudinal cohort study; Longterm Follow-up; Magnetic Resonance Imaging; Measurement; Measures; Medical Records; Multi-Ethnic Study of Atherosclerosis; Myocardial Infarction; Myocardial Ischemia; Outcome; Participant; Pathology; Pharmaceutical Preparations; Play; Population; Populations at Risk; Prevalence; Race; Recommendation; Records; Risk; Risk Factors; Role; Sampling; Stroke; Structure; Subgroup; Sum; System; Testing; Time; Troponin; United States Department of Veterans Affairs; Variant; Veterans; Visit; Woman; Work; adverse outcome; blood pressure medication; blood pressure reduction; blood pressure variability; cardiogenesis; cardiovascular risk factor; clinical Diagnosis; clinical risk; cohort; high risk; hypoperfusion; improved; men; mortality; preservation; risk prediction; risk stratification; sex; treatment strategy

Project Summary/Abstract Blood pressure variability (BPv) is increasingly appreciated as a risk factor for cardiovascular disease. However, few studies have examined the relationship between BPv and heart failure (HF), a serious condition with increasing prevalence in the US. Moreover, in those studies that have indicated a role for BPv in HF risk, several issues merit systematic exploration, including the potential importance of diastolic BPv, contributions of various antihypertensive medication classes to BPv, and further understanding of mechanisms linking BPv to risk of HF. Here, leveraging two complementary data sources—the longitudinal Multi-Ethnic Study of Atherosclerosis (MESA) and the Veterans Affairs’ electronic medical records (VA-EMR), we propose to conduct a comprehensive investigation of the role of BPv in risk of HF guided by the following aims: In Aim 1, we will examine the relationship between visit-to-visit systolic and diastolic BPv and risk of clinically and radiologically identified HF in the MESA cohort. (1a) We will determine the association of BPv with clinical and MRI assessments of HF and whether this differs by baseline determinants including sex, diabetes status, and race/ethnicity. (1b) Then, we will examine potential mechanisms by which BPv may influence HF. We will test whether effects of BPv are enhanced in the setting of lower blood pressure, underlying ischemia, and dips rather than elevations in DBP. We will further assess whether BPv is related to structural changes of HF as measured by MRI imaging. In Aim 2, we will examine the real-world relationship between BPv and risk of HF among participants in the VA national database. (2a) We will examine this in the whole cohort and then test whether the association differs by baseline determinants such as sex, diabetes status, CVD status, and race/ethnicity. The extensive medication database will be used to examine how the BPv association with HF differs by medication class. (2b) To explore mechanisms by which BPv may influence HF, we will examine BPv in those with progressively lower mean blood pressure, evaluate dips rather than rises in DBP and determine whether the relationship is altered in those with underlying ischemia or prior myocardial infarction. In sum, this project is a definitive study of the relationship between BPv and HF. It will help identify those at greatest risk from BPv, potentially improve risk stratification, and by providing evidence for potential mechanisms of injury will lead to improved blood pressure recommendations and treatment strategies.

项目总结/摘要 血压变异性（BPV）作为心血管疾病的危险因素越来越受到重视。然而，在这方面， 一些研究已经检查了BPV和心力衰竭（HF）之间的关系，HF是一种严重的疾病， 在美国日益流行。此外，在那些表明BPV在HF风险中的作用的研究中， 值得系统探讨的问题，包括舒张压的潜在重要性，各种因素的贡献， 抗高血压药物类别与BPv的关系，以及进一步了解BPv与HF风险之间的联系机制。 在这里，利用两个互补的数据源-纵向多种族研究的动脉粥样硬化 （梅萨）和退伍军人事务部的电子病历（VA-EMR），我们建议进行全面的 Bpv在HF风险中的作用的研究由以下目的指导：在目的1中，我们将检查 访视间收缩压和舒张压与临床和影像学确定的HF风险之间的关系 在梅萨队列中。(1a)我们将确定BPv与HF的临床和MRI评估的相关性， 这是否因基线决定因素（包括性别、糖尿病状态和种族/民族）而不同。(1b)然后我们 将研究BPV可能影响HF的潜在机制。我们将测试BPV的影响是否 在低血压、潜在缺血和DBP下降而不是升高的情况下增强。 我们将进一步评估BPV是否与通过MRI成像测量的HF结构变化相关。在Aim中 2，我们将在VA国家参与者中检查BPV和HF风险之间的真实关系， 数据库(2a)我们将在整个队列中检验这一点，然后检验这种关联是否因基线而异 决定因素如性别、糖尿病状态、CVD状态和种族/民族。广泛的药物数据库 将用于检查BPV与HF的相关性如何因药物类别而异。(2b)探讨 Bpv可能影响HF的机制，我们将在平均血流量逐渐降低的患者中检查Bpv 压力，评估DBP的下降而不是上升，并确定是否在那些与舒张压相关的患者中改变了关系。 潜在缺血或既往心肌梗死。总之，这个项目是一个确定性的研究关系， BPV和HF之间的关系。它将有助于识别那些最有可能感染BPV的人，潜在地改善风险分层， 并通过提供损伤的潜在机制的证据将导致血压的改善 建议和治疗策略。