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Chronic Lower Leg Heating for the Treatment of Hypertension in Older Women

慢性小腿加热治疗老年女性高血压

基本信息

批准号：
10366047
负责人：
QI FU
金额：
$ 56.58万
依托单位：
UT SOUTHWESTERN MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-03-01 至 2023-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10366047
关键词：
Adjuvant Antihypertensive Agents Bathing Biological Availability Blood Pressure Blood Vessels Blood Volume Blood flow Body Temperature Cardiovascular Diseases Cardiovascular system Cause of Death Chlorthalidone Chronic Control Groups Cutaneous Cutaneous Muscle Data Diastolic blood pressure Diuretics Doppler Ultrasound Dose Effectiveness Enrollment Ensure Equipment Exposure to Frequencies Guidelines Health Heat Stress Disorders Heating Home Hour Human Human Resources Hypertension Immersion Individual Knee Laboratories Lead Leg Limb structure Microdialysis Modality Morbidity - disease rate Nitrates Nitric Oxide Nitrites Oral Outcome Patients Personal Satisfaction Pharmaceutical Preparations Pharmacological Treatment Pharmacotherapy Prevalence Protocols documentation Public Health Randomized Regimen Research Research Project Grants Resistance Risk Sauna Skin Standardization Techniques Temperature Testing Therapeutic Therapeutic heat application Time Tissues Training Trees United States Vascular resistance Vasoconstrictor Agents Vasodilator Agents Water Woman base blood pressure control blood pressure medication blood pressure reduction blood pressure regulation cardiovascular risk factor clinical practice compliance behavior drug standard effective therapy evidence base group intervention hypertension control hypertension treatment hypertensive improved indexing insight interstitial mortality neuroregulation older men older women patient population patient safety pressure relating to nervous system response shear stress therapy adherence tonometry treatment strategy vascular bed vasoconstriction

项目摘要

PROJECT SUMMARY The prevalence of hypertension is greater in older (≥65 years) women than in older men, while the blood pressure (BP) control rate is lower in older women in the United States. Uncontrolled hypertension is a major risk factor for cardiovascular morbidity and mortality. Despite standard therapy and adherence to optimal drug regimens, over 50% of older hypertensive women still have inadequate BP control (e.g. >140/90 mmHg), and the control rate is further reduced with more aggressive BP targets recommended recently by the new 2017 ACC/AHA Hypertension Guidelines. Thus, the effectiveness of drug treatment alone in the control of hypertension among older women is limited; hence, non-pharmacological approaches are also needed to help reduce BP and cardiovascular morbidity and mortality in older hypertensive women. One adjuvant, non- pharmacological approach that offers promise in lowering BP is “heat therapy”. Indeed, repeated (chronic) whole-body heat exposure has been found to decrease BP in healthy humans. Whether this is also true after regional limb heating in hypertensive patients is unknown. The global objectives of this research project are to investigate the BP lowering effect of home-based lower leg heat therapy in older women with hypertension, and to examine the impact of this therapeutic modality on neural-vascular health in these patients. Specific Aim 1 will test the hypothesis that chronic lower leg heat therapy combined with an antihypertensive drug is superior to drug treatment alone in lowering BP in older hypertensive women. We will randomly assign older hypertensive women to either an intervention group or a control group. Patients in the intervention group will perform 8 weeks of home-based lower leg heat therapy via water immersion up to the knee in a circulated bath (water temperature 42°C, 4 times per week, 45 min per session), whereas patients in the control group will immerse their legs in a thermoneutral water bath (33°C) at the same frequency and duration. All patients will also receive a fixed dose of chlorthalidone (a diuretic, 25 mg orally once daily). We will compare ambulatory BP, the BP control rate, and patient adherence and acceptability to treatment between the groups. Specific Aim 2 will test the hypothesis that chronic lower leg heat therapy will improve nitric oxide bioavailability which can decrease sympathetic vasoconstriction and improve vascular function in older hypertensive women. We will use state-of-the-art techniques of microneurography, Doppler ultrasound, applanation tonometry, and cutaneous microdialysis to assess sympathetic neural control, indices of conduit and resistance vessel vasodilator function, and interstitial metabolites (i.e. nitrate and nitrite) indicative of basal nitric oxide bioavailability in all patients enrolled in Aim 1 before and after 8 weeks of heat therapy. Information obtained from this research project will guide evidence-based clinical practice. It is anticipated that our study may lead to revision of hypertension guidelines to incorporate home-based heat therapy as adjuvant to antihypertensive drug(s) for older women, as well as other patient populations.

项目总结