Improving Blood Pressure Screening and Treatment Strategies in Young Adults

项目摘要 在过去的几十年里，美国心血管疾病(CVD)发病率的总体下降并没有 扩大到18-39岁的年轻人。心血管疾病危险因素在年轻人中的患病率不断上升， 包括高血压在内，可能是心血管疾病发病率增加的原因之一。约20%的美国年轻人 成人有1级或2级高血压(分别为BP130~139/80~89 mm Hg和≥140/90 mm Hg)。尽管 在年轻人中高血压的高患病率及其与心血管疾病的关联，几乎没有证据表明 指导年轻人的BP筛查和治疗建议。对于BP筛查，25%的年轻人 在美国，患有高血压的人没有意识到自己患有高血压。此外，健康的社会决定因素(SDOH)，以及 对年轻人健康的重要影响，在BP筛查建议中没有考虑。对于BP 管理方面，在青壮年开始服用降压药的好处尚不清楚，而且 是从老年人的数据中推断出来的。由于缺乏证据，1300万年轻人中的大多数 有1期高血压的患者目前不建议开始服用降压药，而50%(2.5 2期高血压的青壮年患者中有1/4(百万)目前没有得到治疗。虽然随机对照 具有硬CVD结果的试验(RCT)将提供确凿的证据，执行此类试验可能不可行 在年轻人中进行试验，因为确定心血管疾病风险降低需要高昂的成本和较长的随访时间 福利。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在临床上提供 以经济高效的方式为决策者、患者和临床医生提供相关和可操作的证据。这个 总体研究目标是确定年轻人的最佳血压筛查间隔，并确定 那些早产和/或终生心血管疾病风险较高的人，可能受益于降压药 在年轻的成年期。本研究的目的是(1)通过检查 从正常血压过渡到1或2期高血压的时间和长期血压轨迹，(2)确定 患有1、2期高血压的青壮年患不良心血管或肾脏疾病的高危人群的特征 结果，(3)量化降压药物对处于第一阶段的年轻人的益处和危害 或2高血压，通过使用大型观察性数据库和最先进的技术来模拟假想的RCT 减少混淆和选择偏差的统计模型，以及(4)比较短期和长期健康 以及AIMS 1至10中确定的针对美国年轻人的BP筛查和管理策略的经济影响 3与英国石油公司目前的指导方针相比。为了实现这些目标，我们将研究约50万名18-39岁的年轻人 来自南加州的Kaiser Permanente和四个流行病学队列。这项研究的发现将 告知未来的BP指南，通过指导高风险的筛查和治疗来减少健康不平等 亚组，并改善美国年轻人的心血管健康。

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.