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.

项目概要/摘要 高血压是心血管疾病 (CVD) 的重要危险因素，这一点毋庸置疑。老年人是 在美国，三分之二的 60 岁以上成年人受到高血压的影响尤为严重 高血压。抗高血压药物对减少 CVD 的益处已在人群中得到证实 患有高血压的老年人。然而，越来越多的数据表明抗高血压药物 强化可能与患有高血压的老年人跌倒风险增加有关。当跌倒时 与接受治疗的老年高血压患者的显着发病率和死亡率相关，临床医生认为 对在这一人群中加强抗高血压药物治疗持谨慎态度。临床血压 (BP) 属于 医疗保健提供者在抗高血压药物决策中使用的因素 集约化。然而，诊所外的血压可能低于诊所血压，并且波动较大 全天。因此，临床外血压可能是与以下因素相关的更具临床相关性的生理测量： 瀑布。动态血压监测 (ABPM) 以自然的方式量化 24 小时内的诊所外血压 环境。 ABPM 可用于评估白大衣效应，定义为临床与临床之间的差异 动态血压和白大衣高血压，定义为临床血压升高但动态血压未升高 血压。 ABPM 还可以评估 24 小时内血压变化的幅度以及餐后血压下降， 饭后血压下降。本研究的目的是确定更大的白大衣效应和 其次，餐后血压下降与 24 小时内的血压变化风险增加相关 发生在接受治疗的老年高血压患者中。此外，该研究还将确定人口统计和 与较大白大衣效应、血压变异性和餐后血压下降相关的临床因素。到 为了实现这些目标，我们将招募来自南加州 Kaiser Permanente 的 1057 名 65 岁以上患者 有高血压病史并正在服用抗高血压药物的人。人口统计、临床 特征、老年评估（虚弱、认知受损、活动能力受损、功能障碍和身体状况） 性能），并且将在基线上执行 24 小时 ABPM。跌倒和严重跌倒受伤（骨折、关节 脱臼和脑损伤）将在一年的随访期内进行前瞻性评估。当决定时 为了加强抗高血压药物治疗，医疗保健提供者和患者面临着权衡 预防 CVD 事件的潜力与增加跌倒的可能性。由于诊所外血压可能更 与临床血压相比，ABPM 是跌倒风险的相关生理测量方法，作为支持跌倒风险的工具，ABPM 前景广阔。 为老年高血压患者提供个体化护理。 ABPM 可能在识别 患有高血压的老年人可以安全地进行降压药物强化治疗，或者 否则可以避免。