Haemodynamic Determinants Of HYpertension In Children And Young People And Role Of The Sympathetic Nervous System: HY CYP

儿童和青少年高血压的血流动力学决定因素以及交感神经系统的作用：HY CYP

• 批准号: MR/X001768/1
• 负责人: Emily Haseler
• 金额: $ 39.04万
• 依托单位: King's College London
• 依托单位国家: 英国
• 项目类别: Fellowship
• 财政年份: 2022
• 资助国家: 英国
• 起止时间: 2022 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FX001768%2F1
• 关键词: Haemodynamic; Determinants; HYpertension; Children; Young

BackgroundAround a third of the adult population suffers from high blood pressure (medically known as "hypertension"). If left untreated, hypertension is a major risk factor for having a heart attack or a stroke. Put together these cause the largest number of deaths each year in the world. A lot of research has been conducted into the changes that take place in the body in adults with hypertension but not much is known about what causes hypertension in children. More and more children are being diagnosed with high blood pressure - partly because doctors are checking for it more, but also because it is a common problem that develops alongside being overweight. Children and young people are unfortunately becoming more overweight over time. This means it is becoming increasingly important to find out what causes hypertension in children and young people so we can offer the best treatment. It is also important because hypertension in children often leads on to hypertension in adults.Hypertension can be caused either by the heart pumping too fast or too hard for the body's needs (cardiac overactivity), or by the blood vessels that carry the blood away from the heart becoming stiff or narrowed. Old studies suggest that hypertension is caused mainly by alterations in blood vessels. Some more recent evidence, including work from our group suggests that it is the heart beating harder and faster that is the main problem in young people. We would like to look at this in more detail and try to ascertain the cause of any cardiac overactivity we find. We suspect that young people with hypertension have increased "fight or flight" activity (called sympathetic nervous system activity) and we will use breathing exercises and medication to try and block this activity to see what difference this makes to blood pressure in children and young adults with hypertension.Aims: This project will use state of the art blood pressure measurements and heart scans to measure the flow of blood in the heart and blood vessels of children and young people with hypertension and compare it to those without hypertension. We will also manipulate some of the messages getting from the brain to control the heart and blood vessels.Objectives: - We will use sophisticated imaging techniques (ultrasound and magnetic resonance imaging technology or MRI) to study in detail how the flow of blood through the heart and the blood vessels varies between young people with hypertension and with normal blood pressure. - We will use breathing exercises to reduce the heart rate and volume of blood pumped during each heartbeat and see whether this has a greater effect in young people with hypertension or young people with normal blood pressure. - We will use two medicines that work to reduce blood pressure in different ways and assess what effect these medications have on how the heart pumps and how the blood flows through the blood vessels. ImpactIf we confirm our hypothesis that children and young people with high blood pressure have increased cardiac activity and not increased resistance in their blood vessels, it would lead to a shift in the way we think about high blood pressure in children and young adults. Many of the medications we use target the blood vessels and may therefore not be the best medications to use in young people. We hope this research will lead to a clinical trial comparing how well different types of blood pressure medication work in this age group of patients. This research will also be one of the first studies to use MRI to study blood flows in hypertension in this age group, and the first study to manipulate the "fight or flight" response for children without using invasive and painful techniques.

背景大约三分之一的成年人患有高血压（医学上称为“高血压”）。如果不及时治疗，高血压是心脏病发作或中风的主要危险因素。这些因素加在一起每年造成的死亡人数是世界上最多的。人们对成年高血压患者体内发生的变化进行了大量研究，但对儿童高血压的病因知之甚少。越来越多的儿童被诊断患有高血压-部分原因是医生检查得越来越多，但也因为这是一个伴随超重而发展的常见问题。不幸的是，随着时间的推移，儿童和年轻人越来越超重。这意味着找出导致儿童和青少年高血压的原因变得越来越重要，以便我们能够提供最佳治疗。儿童高血压通常会导致成人高血压，这一点也很重要。高血压可能是由于心脏泵血过快或过强而无法满足身体的需要（心脏过度活动），或者是由于将血液从心脏输送出去的血管变得僵硬或狭窄。过去的研究表明，高血压主要是由血管的改变引起的。最近的一些证据，包括我们小组的工作表明，年轻人的主要问题是心脏跳动得更快更快。我们想更详细地研究这一点，并试图确定我们发现的任何心脏过度活动的原因。我们怀疑年轻的高血压患者增加了“战斗或逃跑”的活动（称为交感神经系统活动），我们将使用呼吸练习和药物来尝试阻止这种活动，看看这对患有高血压的儿童和年轻人的血压有什么影响。目的：该项目将使用最先进的血压测量和心脏扫描来测量儿童和青少年高血压患者心脏和血管中的血流，与没有高血压的人相比。我们还将操纵从大脑获得的一些信息来控制心脏和血管。目的：-我们将使用先进的成像技术（超声和磁共振成像技术或MRI）来详细研究高血压和正常血压的年轻人之间通过心脏和血管的血液流动如何变化。- 我们将使用呼吸练习来降低心率和每次心跳时泵出的血液量，看看这是否对高血压年轻人或血压正常的年轻人有更大的影响。- 我们将使用两种以不同方式降低血压的药物，并评估这些药物对心脏泵血和血液流经血管的影响。如果我们证实我们的假设，即儿童和青少年高血压患者的心脏活动增加，而不是血管阻力增加，这将导致我们对儿童和青少年高血压的看法发生转变。我们使用的许多药物都是针对血管的，因此可能不是年轻人使用的最佳药物。我们希望这项研究将导致一项临床试验，比较不同类型的血压药物在这个年龄组的患者中的效果。这项研究也将是首批使用MRI研究该年龄组高血压血流的研究之一，也是第一项在不使用侵入性和痛苦技术的情况下操纵儿童“战斗或逃跑”反应的研究。