Ambulatory blood pressure and falls in older treated patients with hypertension

接受治疗的老年高血压患者的动态血压和跌倒情况

• 批准号: 10163696
• 负责人: Kristi Reynolds
• 金额: $ 74.99万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10163696
• 关键词: Address; Adult; Affect; Age; Age-Years; Alcohol consumption; Ambulatory Blood Pressure Monitoring; Antihypertensive Agents; Anxiety; Blood Pressure; Body mass index; Brain Injuries; Calendar; California; Cardiovascular Diseases; Cardiovascular system; Cessation of life; Characteristics; Chronic Kidney Failure; Clinic; Clinical; Data; Decision Making; Diabetes Mellitus; Elderly; Electronic Health Record; Enrollment; Environment; Ethnic Origin; Event; Fall prevention; Fracture; Geriatric Assessment; Goals; Health Personnel; Hospitalization; Hour; Hypertension; Impaired cognition; Individual; Injury; Inpatients; Joint Dislocation; Link; Measures; Mental Depression; Monitor; Morbidity - disease rate; Observational Study; Outpatients; Parkinson Disease; Patients; Pharmaceutical Preparations; Physical Performance; Physiological; Population; Prevention strategy; Prospective Studies; Public Health; Race; Recording of previous events; Risk; Risk Factors; Role; Smoking; Testing; Time; Visit; aged; blood pressure variability; cardiovascular disorder risk; clinical decision-making; clinically relevant; demographics; design; ethnic diversity; evidence base; fall injury; fall risk; falls; follow-up; frailty; functional disability; high risk; hypertension treatment; mortality; perceived stress; personalized care; prevent; prospective; racial and ethnic; routine care; sex; tool; white coat hypertension

Project Summary/Abstract Hypertension is a cardiovascular disease (CVD) risk factor of unquestionable importance. Older adults are disproportionally affected by hypertension with two thirds of adults 60+ years of age in the U.S. having hypertension. The CVD reduction benefits of antihypertensive medication have been demonstrated among older adults with hypertension. However, accumulating data suggest antihypertensive medication intensification may be associated with an increased risk of falls among older adults with hypertension. As falls are associated with substantial morbidity and mortality in older treated adults with hypertension, clinicians are wary about intensifying antihypertensive medication in this population. Clinic blood pressure (BP) is among the factors used by health care providers in the decision-making regarding antihypertensive medication intensification. However, BP outside of the clinic setting can be lower than clinic BP and have large fluctuations throughout the day. Therefore, out-of-clinic BP may be a more clinically relevant physiologic measure linked to falls. Ambulatory BP monitoring (ABPM) quantifies out-of-clinic BP over a 24-hour period in the naturalistic setting. ABPM can be used to assess the white coat effect, defined as the difference between clinic and ambulatory BP, and white coat hypertension, defined as having elevated clinic but non-elevated ambulatory BP. ABPM can also assess the magnitude of BP variability over 24 hours as well as postprandial BP decline, the BP decline following meals. The aims of this study are to determine whether a larger white coat effect and BP variability over 24 hours and secondarily, postprandial BP decline are associated with an increased risk of falls among older treated adults with hypertension. Further, the study will also identify the demographic and clinical factors associated with a larger white coat effect, BP variability, and postprandial BP decline. To address these aims, we will enroll 1057 patients 65+ years of age from Kaiser Permanente Southern California who have a history of hypertension and are taking antihypertensive medication. Demographics, clinical characteristics, geriatric assessments (frailty, impaired cognition, mobility, functional impairment and physical performance), and 24-hour ABPM will be performed at baseline. Falls and serious fall injuries (fractures, joint dislocations, and brain injuries) will be assessed prospectively over a 1-year follow-up period. When deciding to intensify antihypertensive medication, health care providers and patients are faced with trade-offs between the potential for preventing CVD events vs. the possibility of increasing falls. As out-of-clinic BP may be a more relevant physiologic measure of fall risk than clinic BP, ABPM holds great promise as a tool to support individualized care for older treated adults with hypertension. ABPM may have an essential role for identifying older adults with hypertension in whom antihypertensive medication intensification can safely be undertaken or otherwise avoided.

项目摘要/摘要 高血压是一种心血管疾病（CVD）的危险因素，这是无疑重要性的。老年人是 在美国，受到高血压的影响不成比例，在美国，有三分之二的成年人有60岁以上的成年人 高血压。在 高血压的老年人。但是，累积数据表明降压药 高血压老年人的跌倒风险可能增加。作为瀑布 与高血压的老年人相关的大量发病率和死亡率有关，临床医生是 警惕加强该人群中的降压药。临床血压（BP）是 医疗保健提供者在决策中使用的有关降压药的因素 集约化。但是，诊所环境外的BP可以低于诊所BP，并且波动很大 整天。因此，临床外BP可能是与临床相关的生理指标 瀑布。在自然主义的24小时内，卧床BP监测（ABPM）在24小时内量化了临床外BP 环境。 ABPM可用于评估白色外套效应，定义为诊所和 门诊BP和白色外套高血压定义为诊所升高但非卧床 bp。 ABPM还可以评估24小时内BP变异性的幅度以及餐后BP下降， 饭后的BP下降。这项研究的目的是确定较大的白色外套效应和 BP可变性在24小时内，其次，餐后BP下降与增加的风险有关 在老年患有高血压的老年人中落入。此外，该研究还将确定人口统计和 临床因素与较大的白色外套作用，BP变异性和餐后BP下降相关。到 解决这些目的，我们将从Kaiser Permanente南加州注册1057例65岁以上的患者 有高血压史，正在服用降压药。人口统计，临床 特征，老年评估（脆弱，认知受损，流动性，功能障碍和身体 性能）和24小时ABPM将在基线上进行。跌倒和严重的跌倒伤害（骨折，关节 脱位和脑损伤）将在1年的随访期间前瞻性评估。决定时 为了加强降压药，医疗保健提供者和患者面临着权衡 防止CVD事件的潜力与增加跌倒的可能性。因为临床外的bp可能更多 与诊所BP相比，相关的跌倒风险的生理测量，ABPM具有巨大的希望作为支持的工具 针对高血压老年人治疗的成年人的个性化护理。 ABPM可能在识别 高血压的老年人可以安全地进行降压药加工或 否则避免了。