Improved Characterization of Postural Blood Pressure Change in Older Adults

项目总结/摘要 Stephen Juraschek，医学博士，博士，是约翰斯大学普通内科的研究员。 霍普金斯大学医学院。他正在申请一个指导病人为导向的研究生涯 发展（K23）奖，题为“改善老年人体位血压变化的特征”。 他严格的训练和令人印象深刻的研究机构为他职业生涯的下一阶段做好了准备。 通过这个奖项，斯蒂芬将成功地从一个科学家过渡到精通进行中学 将数据分析交给独立的临床研究者，该研究者擅长生成干预试验的原始数据 旨在预防和治疗老年人血压相关的心血管疾病。 Stephen在短短六年内完成了他的MD-PhD培训，拥有强大的流行病学基础， 生物统计学他在发表对已完成的研究的二次分析方面表现出很大的才能 专注于心血管疾病和高血压。K23的提议，代表了一个机会， 斯蒂芬获得必要的技能，成为一名独立的临床研究者。这些技能 包括（1）在原始数据收集方面严格的实践经验和（2）先进的分析技术 与临床研究的设计和实施相关，包括采用适应性设计的试验。 Stephen的建议集中在直立性低血压，这是一种非常重要但定义不清的副作用， 老年人的降压治疗。他的提议包括一个5年计划，该计划利用 一项由美国国立卫生研究院资助的试验，目的是：（1）在1100例受试者中使用连续喂养装置描述直立性低血压的特征 STURDY（横断面验证研究）的参与者;（2）确定 直立性低血压伴随后的福尔斯（前瞻性队列研究）;和（3）评估维生素D是否 降低体位性低血压的患病率并减轻其症状（反应适应性临床试验）。 成功完成这一提案将回答围绕评估的持续争议， 描述直立性低血压与相关临床结局的关系，并评价一种新的 治疗直立性低血压。 斯蒂芬的研究将在约翰霍普金斯大学丰富、多样和协作的环境中进行 在由医学博士劳伦斯阿佩尔领导的一组专职教师导师的指导和支持下， 公共卫生硕士和埃德加米勒博士，医学博士，博士。他的导师团队是真正的多学科教师从 约翰霍普金斯医学院、护理学院和公共卫生学院。这个团队将确保斯蒂芬 出现了以患者为中心的专业知识，主要数据收集，复杂的数据分析和技能， 试验设计和分析，包括适应性设计。由于这一指导培训， 斯蒂芬将完全具备作为一个独立的临床研究者，专注于 老年人血压相关心血管疾病的预防和治疗。

Project Summary/Abstract Stephen Juraschek, MD, PhD, is a research fellow in the Division of General Internal Medicine at Johns Hopkins University, School of Medicine. He is applying for a Mentored Patient-Oriented Research Career Development (K23) Award, titled “Improved characterization of postural blood pressure change in older adults.” His rigorous training and impressive body of research have prepared him for this next phase of his career. Through this award, Stephen will successfully transition from a scientist proficient in conducting secondary data analyses to an independent clinical investigator, skilled in generating primary data in trials of interventions designed to prevent and treat blood pressure-related cardiovascular disease in older adults. Stephen completed his MD-PhD training in just six years with a strong foundation in epidemiology and biostatistics. He has demonstrated great aptitude in publishing secondary analyses of completed studies focused on cardiovascular disease and hypertension. This K23 proposal, represents an opportunity for Stephen to acquire the skills that are necessary to become an independent clinical investigator. These skills include (1) a rigorous, hands-on experience in primary data collection and (2) advanced analytic techniques related to the design and conduct of clinical studies, including trials with adaptive designs. Stephen's proposal focuses on orthostatic hypotension, an incredibly important yet poorly defined side effect of antihypertensive therapy in older adults. His proposal includes a 5-year plan that leverages the infrastructure of a funded NIH trial to: (1) characterize orthostatic hypotension using a continuous feed device in 1100 participants of STURDY (cross-sectional validation study); (2) determine the association of novel metrics of orthostatic hypotension with subsequent falls (prospective cohort study); and (3) evaluate whether vitamin D lowers the prevalence of orthostatic hypotension and reduces its symptoms (response-adaptive clinical trial). Successful completion of this proposal will answer ongoing controversies surrounding the assessment and characterization of orthostatic hypotension in relation to relevant clinical outcomes as well as evaluate a novel treatment of orthostatic hypotension. Stephen's research will occur in the rich, diverse, and collaborative environment at Johns Hopkins University under the guidance and support of a dedicated group of faculty mentors, led by Dr. Lawrence Appel, MD, MPH, and Dr. Edgar Miller, MD, PhD. His mentorship team is truly multidisciplinary with faculty from the Johns Hopkins Schools of Medicine, Nursing, and Public Health. Together, this team will ensure that Stephen emerges with expertise in patient-centered, primary data collection, complex data analysis, and skills in the design and analysis of trials, including those with adaptive designs. As a result of this mentored training, Stephen will be fully equipped for a highly productive career as an independent clinical investigator focused on the prevention and treatment of blood pressure-related cardiovascular disease in older adults.