Role and Mechanism of Blood Pressure Variability in Risk of Heart Failure

血压变异在心力衰竭风险中的作用和机制

• 批准号: 10548216
• 负责人: Daniel Sevag Nuyujukian
• 金额: $ 7.38万
• 依托单位: UNIVERSITY OF ARIZONA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-19 至 2024-01-18
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10548216
• 关键词: Accounting; Antihypertensive Agents; Blood Pressure; Cardiovascular Diseases; Cardiovascular system; Characteristics; Clinical; Clinical/Radiologic; Communities; Computerized Medical Record; Coronary; Coronary heart disease; Data; Data Sources; Databases; Development; Diabetes Mellitus; Diagnosis; Diastole; Diastolic blood pressure; EFRAC; Epidemiology; Ethnic Origin; Event; Foundations; Future; Healthcare Systems; Heart failure; Image; Injury; Investigation; Ischemia; Link; Longitudinal cohort study; Longterm Follow-up; Magnetic Resonance Imaging; Measurement; Measures; Medical Records; Multi-Ethnic Study of Atherosclerosis; Myocardial Infarction; Myocardial Ischemia; Outcome; Participant; Pathology; Pharmaceutical Preparations; Play; Population; Populations at Risk; Prevalence; Race; Recommendation; Risk; Risk Factors; Role; Sampling; Stroke; Subgroup; System; Testing; Time; Troponin; United States Department of Veterans Affairs; Variant; Veterans; Visit; Woman; Work; adverse outcome; blood pressure elevation; blood pressure medication; blood pressure reduction; blood pressure variability; cardiac magnetic resonance imaging; cardiovascular risk factor; clinical diagnosis; clinical risk; cohort; electronic recording system; high risk; hypoperfusion; improved; men; mortality; preservation; risk prediction; risk stratification; sex; treatment strategy

Project Summary/Abstract Blood pressure variability (BPv) is increasingly appreciated as a risk factor for cardiovascular disease. However, few studies have examined the relationship between BPv and heart failure (HF), a serious condition with increasing prevalence in the US. Moreover, in those studies that have indicated a role for BPv in HF risk, several issues merit systematic exploration, including the potential importance of diastolic BPv, contributions of various antihypertensive medication classes to BPv, and further understanding of mechanisms linking BPv to risk of HF. Here, leveraging two complementary data sources—the longitudinal Multi-Ethnic Study of Atherosclerosis (MESA) and the Veterans Affairs’ electronic medical records (VA-EMR), we propose to conduct a comprehensive investigation of the role of BPv in risk of HF guided by the following aims: In Aim 1, we will examine the relationship between visit-to-visit systolic and diastolic BPv and risk of clinically and radiologically identified HF in the MESA cohort. (1a) We will determine the association of BPv with clinical and MRI assessments of HF and whether this differs by baseline determinants including sex, diabetes status, and race/ethnicity. (1b) Then, we will examine potential mechanisms by which BPv may influence HF. We will test whether effects of BPv are enhanced in the setting of lower blood pressure, underlying ischemia, and dips rather than elevations in DBP. We will further assess whether BPv is related to structural changes of HF as measured by MRI imaging. In Aim 2, we will examine the real-world relationship between BPv and risk of HF among participants in the VA national database. (2a) We will examine this in the whole cohort and then test whether the association differs by baseline determinants such as sex, diabetes status, CVD status, and race/ethnicity. The extensive medication database will be used to examine how the BPv association with HF differs by medication class. (2b) To explore mechanisms by which BPv may influence HF, we will examine BPv in those with progressively lower mean blood pressure, evaluate dips rather than rises in DBP and determine whether the relationship is altered in those with underlying ischemia or prior myocardial infarction. In sum, this project is a definitive study of the relationship between BPv and HF. It will help identify those at greatest risk from BPv, potentially improve risk stratification, and by providing evidence for potential mechanisms of injury will lead to improved blood pressure recommendations and treatment strategies.

项目摘要/摘要 血压变异性(BPV)越来越被认为是心血管疾病的危险因素。然而， 很少有研究研究BPV与心力衰竭(HF)的关系，心力衰竭是一种严重的 在美国的流行率越来越高。此外，在那些表明牛细小病毒在心力衰竭风险中的作用的研究中，有几项 值得系统探讨的问题，包括舒张期BPV的潜在重要性，各种因素的贡献 降压药物与BPV的分类，以及进一步了解BPV与心力衰竭风险之间的联系机制。 在这里，利用两个互补的数据来源-动脉粥样硬化的纵向多种族研究 (MESA)和退伍军人事务部电子病历(VA-EMR)，我们建议进行全面的 BPV在心力衰竭风险中的作用的研究遵循以下目标：在目标1中，我们将研究 就诊间收缩和舒张期BPV与临床和放射学确诊的心衰风险的关系 在梅萨的队列中。(1A)我们将确定BPV与心力衰竭的临床和MRI评估之间的关系 这是否会因性别、糖尿病状况和种族/民族等基线决定因素而有所不同。(1B)然后，我们 将研究BPV可能影响HF的潜在机制。我们将测试BPV的影响是否 在较低的血压、潜在的缺血和DBP下降而不是升高的情况下增强。 我们将进一步评估BPV是否与磁共振成像测量的HF的结构变化有关。在AIM 2，我们将研究退伍军人管理局国家参与者中BPV与心力衰竭风险之间的现实关系 数据库。(2A)我们将在整个队列中检查这一点，然后测试这种关联是否因基线而不同 决定因素，如性别、糖尿病状况、心血管疾病状况和种族/民族。广泛的药物数据库 将被用来检查BPV与心力衰竭的关联如何因药物类别而异。(2B)探索 BPV可能影响HF的机制，我们将检查那些平均血液逐渐降低的人的BPV 压力，评估DBP的下降而不是上升，并确定这种关系是否在有 潜在的缺血或既往心肌梗死。总之，这个项目是对这一关系的明确研究 在BPV和HF之间。它将有助于识别BPV的最大风险人群，潜在地改善风险分层， 通过为潜在的损伤机制提供证据，将导致血压改善 建议和治疗策略。