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）的发病率总体下降， 扩大到18-39岁的年轻人。年轻人心血管疾病危险因素的患病率增加， 包括高血压（BP），可能导致CVD率的增加。大约20%的美国年轻人 成人为1级或2级高血压（BP分别为130-139/80-89 mm Hg和≥140/90 mm Hg）。尽管 年轻人高血压的高患病率及其与CVD的相关性，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，高血压患者并不知道自己患有高血压。此外，健康的社会决定因素（SDOH）， 对年轻人的健康有重要影响，在BP筛查建议中没有考虑。为BP 管理，在年轻的成年开始抗高血压药物的好处是未知的， 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 目前不建议1期高血压患者开始使用降压药物，50%（2.5 2000万）的年轻成年人患有2期高血压，目前没有得到治疗。虽然随机对照 具有硬CVD结局的随机对照试验（RCT）将提供明确的证据， 由于确定CVD风险降低所需的高成本和长随访时间， 效益在没有随机对照试验的情况下，高质量的观察性和模拟研究可以在临床上提供 以具有成本效益的方式为政策制定者、患者和临床医生提供相关和可操作的证据。的 总体研究目标是确定年轻成人的最佳BP筛查间隔， 过早和/或终身CVD的高风险人群，可能受益于抗高血压药物 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级或2级高血压的时间和长期血压轨迹，（2）确定 患有1期或2期高血压的年轻成人的特征，这些高血压患者具有不良CVD或肾功能损害的高风险。 结果，（3）量化抗高血压药物在1期年轻人中的益处和危害 或2高血压，通过使用大型观察数据库和最新技术水平模拟假设RCT 统计模型，以尽量减少混淆和选择偏差，（4）比较短期和长期的健康 在目标1至10中确定的美国年轻人BP筛查和管理策略的经济影响 3 vs.当前BP指南。为了实现这些目标，我们将研究约50万名18-39岁的年轻人， 来自南加州凯撒医疗机构和四个流行病学队列。这项研究的结果将 为未来的BP指南提供信息，通过指导高危人群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.