BLOOD PRESSURE CONTROL IN HYPERTENSIVE SMOKERS

高血压吸烟者的血压控制

• 批准号: 7440059
• 负责人: Mark W Vander Weg
• 金额: $ 64.21万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-03 至 2009-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7440059
• 关键词: African American; behavior modification; behavior therapy; behavioral /social science research tag; blood pressure; body physical activity; body weight; clinical research; comorbidity; human subject; human therapy evaluation; hypertension; longitudinal human study; nutrient intake activity; patient oriented research; relapse /recurrence; smoking; smoking cessation; tobacco abuse; weight control; weight gain

DESCRIPTION (provided by applicant): High blood pressure (BP) is a major risk factor for cardiovascular morbidity and mortality. Hypertension is associated with an elevated risk for several cardiovascular complications, including coronary heart disease, peripheral vascular disease, congestive heart failure, and stroke, as well as an increased risk for renal disease. Although there have been significant advances in the detection and treatment of high BP, approximately one in four adults in the United States is hypertensive. Cigarette smoking is another highly prevalent and preventable risk factor, accounting for more than 400,000 premature deaths each year in this country alone, making it the leading cause of morbidity and mortality. Evidence from several epidemiological studies has demonstrated that, at any level of BP, smoking substantially increases the risk for all cardiovascular complications associated with hypertension. While cigarette smoking and hypertension both increase the risk of cardiovascular disease, these two risk factors act synergistically to produce a greater risk than their combined independent effects. Despite the considerable health risks, smoking among hypertensives is very common, with a prevalence approaching that observed among those with normal BP. Unfortunately, although quitting smoking is especially important for patients with high BP, smoking cessation produces a nontrivial weight gain averaging 5 kg, which may exacerbate hypertension in many patients with the disorder. Indeed, several studies have documented significant elevations in BP following smoking cessation, as well as increases in the prevalence of hypertension after quitting smoking. As such, it is important to develop effective interventions that assist in quitting smoking and preventing weight gain. Given this introduction, we propose the following specific aims: (1) To recruit 750 smokers with hypertension or prehypertension (based on JNC VII criteria). Given that African Americans are at high risk both for hypertension and post-cessation weight gain, the majority of the cohort recruited will be African American; (2) To provide all participants with a brief, validated, combined behavioral and pharmacologic smoking cessation intervention; and (3) To randomize participants who are abstinent from smoking at the completion of the cessation intervention to: (a) a four-month validated combined weight gain prevention and blood pressure control program; or (b) no additional lifestyle modification. The primary endpoint is change in BP among quit smokers at a one-year follow-up. Secondary endpoints include changes in body weight, dietary intake, urinary sodium excretion, physical activity, and relapse to smoking. Exploratory endpoints include changes in hypertensive status (e.g., movement from prehypertensive to hypertensive by JNC VII criteria) and changes in BP medication status. We anticipate that those assigned to the BP control program will demonstrate more favorable changes in BP, weight, physical activity, and dietary intake at six- and 12-month follow-ups.

描述（由申请人提供）：高血压（BP）是心血管发病率和死亡率的主要危险因素。高血压与多种心血管并发症的风险升高有关，包括冠状动脉疾病，外周血管疾病，充血性心力衰竭和中风，以及增加肾脏疾病的风险。尽管在检测和治疗高BP方面取得了重大进展，但美国大约四分之一的成年人是高血压。吸烟是另一个高度普遍且可预防的危险因素，仅在这个国家，每年就会占40万以上过早死亡，这使其成为发病率和死亡率的主要原因。几项流行病学研究的证据表明，在任何水平的BP上，吸烟大大增加了与高血压相关的所有心血管并发症的风险。尽管吸烟和高血压都增加了心血管疾病的风险，但这两个危险因素在协同上起作用，产生的风险比其联合独立影响更大。尽管有很大的健康风险，但高血压中的吸烟非常普遍，在BP正常患者中观察到的患病率接近。不幸的是，尽管戒烟对于BP高的患者尤其重要，但戒烟会导致非平凡的体重增加5 kg，这可能会加剧许多疾病患者的高血压。实际上，一些研究记录了戒烟后BP的显着升高，以及戒烟后高血压患病率的升高。因此，重要的是制定有助于戒烟并防止体重增加的有效干预措施。鉴于此介绍，我们提出以下具体目的：（1）招募750名具有高血压或预级前的吸烟者（基于JNC VII标准）。鉴于非洲裔美国人的高血压和过量后体重增加既处于高风险，因此招募的大多数队列将是非裔美国人。 （2）为所有参与者提供简短，经过验证的，合并的行为和药理学戒烟干预措施； （3）在戒烟干预完成时禁止吸烟的参与者随机分配：（a）四个月验证的合并体重增加预防和血压控制计划；或（b）没有其他生活方式修改。主要终点是在为期一年的随访中，戒烟者戒烟者的BP变化。次要终点包括体重的变化，饮食摄入量，泌尿钠排泄，体育锻炼以及对吸烟的复发。探索性终点包括高血压状态的变化（例如，通过JNC VII标准从高血压到高血压的运动以及BP药物状况的变化。我们预计分配给BP控制计划的人将在六个月和12个月的随访中表现出BP，体重，体育锻炼和饮食摄入量的更有利的变化。