Reproducibility and Clinical Implications of Masked Hypertension

隐匿性高血压的可重复性和临床意义

基本信息

批准号：
7768929
负责人：
ANTHONY J VIERA
金额：
$ 55.92万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-06-01 至 2013-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7768929
关键词：
Address Adult Agreement Albumins Albuminuria Ambulatory Blood Pressure Monitoring Ambulatory Monitoring Antihypertensive Agents Atherosclerosis Attention Blood Pressure Blood Pressure Monitors C-reactive protein Calcium Cardiac Cardiovascular Diseases Cardiovascular system Cause of Death Center for Translational Science Activities Cessation of life Classification Clinic Clinical Clinical and Translational Science Awards Coronary artery Coronary heart disease Data Detection Diabetes Mellitus Diagnosis Epidemiology Event Glucose Goals Health Heart Diseases High Prevalence Home Blood Pressure Monitoring Home environment Hour Hyperlipidemia Hypertension Investigation Lead Left Ventricular Hypertrophy Left Ventricular Mass Light Lipids Measurement Measures Monitor Morbidity - disease rate North Carolina Occupations Organ Outcome Patients Persons Population Population Attributable Risks Population Control Populations at Risk Prevalence Primary Health Care Procedures Protocols documentation Public Health Recommendation Recruitment Activity Reproducibility Research Research Design Research Personnel Resources Retrospective Studies Risk Risk Assessment Risk Factors Sampling Screening procedure Serum Site Smoker Smoking Son Staging Stratification Stress Stroke Study Subject Testing Translating Treatment/Psychosocial Effects United States Universities Urine base blood pressure regulation cardiovascular disorder risk coronary artery calcification effective therapy experience heart disease risk hypertension treatment imaging modality improved indexing masked hypertension mortality novel psychosocial public health relevance socioeconomics tool trait

项目摘要

DESCRIPTION (provided by applicant): Reproducibility and Clinical Implications of Masked Hypertension Hypertension-the most important cardiovascular disease (CVD) risk factor-can go undetected for one of two main reasons: either a person's blood pressure (BP) is simply not checked (i.e., the person is not screened), or the screening measurement itself does not detect it. Over the past four decades, much effort has been devoted to improving screening rates for detection of high BP. Only recently, however, through the use of 24-hour ambulatory BP monitoring (ABPM), has attention been given to the possibility that "false negative" office BP measurements may be substantial in number and clinically important. Masked hypertension (MH) denotes BP that is not elevated (<140/90 mm Hg) when measured in the office, but elevated when repeated measurements are averaged over the course of a day. The prevalence of MH in the general adult population is estimated to be 10%. Recent data suggest that people with MH have cardiovascular target organ damage and an increase in CVD events of an order of magnitude approaching that seen in people with sustained hypertension (elevated office BP levels with elevated out-of-office BP levels). Many important unresolved questions need to be answered, however, before clinical recommendations can be made. Chief among these is whether MH represents a reproducible phenomenon. Another important consideration is clarifying whether home BP monitoring (HBPM) can be used in place of ABPM to identify MH, and if so, whether it serves to identify the same at-risk population. We aim to (1) assess the reproducibility of MH and evaluate the agreement between HBPM and ABPM in identifying MH, (2) identify demographic, psychosocial, and clinical factors associated with MH, and (3) explore the degree of target organ damage and subclinical atherosclerosis associated with MH. To accomplish these aims, we will perform two sets of office, ABPM, and HBPM BP measurements one week apart on 420 adults not under treatment for hypertension recruited from twelve primary care practices. Other measures will include serum glucose, lipids, and C-reactive protein; urine albumin; left ventricular mass index; coronary artery calcium; perceived stress; job and home strain; and trait-anger. The research team has extensive experience with BP measurement research, psychosocial effects on BP, cardiac imaging methods, coronary heart disease risk assessment, and conducting research in networks of primary care practices. Our study is expected to improve our understanding of the epidemiology and implications of MH and ultimately lead to strategies that will improve detection of high BP in the population. PUBLIC HEALTH RELEVANCE: The possibility that office blood pressure measurements fail to detect hypertension for millions of people demands the kind of rigorous investigations described in the proposed study. The findings are expected to lead to clinical strategies enabling greater recognition of hypertension, and therefore, ultimately to a reduction in cardiovascular morbidity and mortality in the population.

描述（由申请人提供）：掩盖高血压高血压的可重复性和临床意义 - 最重要的心血管疾病（CVD）风险因素 - 危险因素-CAN出于两个主要原因之一而未被发现：一个人的血压（BP）是简单地检查的（即未筛选该人），或者没有筛选测量本身。在过去的四十年中，许多努力一直致力于提高筛选率以检测高BP。然而，直到最近，通过使用24小时的门诊BP监测（ABPM），人们注意到了“假阴性”办公室BP测量的可能性可能很大，并且在临床上很重要。掩盖高血压（MH）表示在办公室中测量时未升高的BP（<140/90 mm Hg），但在一天中平均重复测量时升高。普通成年人口中MH的患病率估计为10％。最近的数据表明，患有MH的患者具有心血管靶器官损害，并且在持续高血压的人（办公室BP升高且外部外部BP水平升高）中，接近的CVD事件的增加了。但是，在提出临床建议之前，需要回答许多重要的未解决问题。其中的主要是MH是否代表可再现现象。另一个重要的考虑因素是阐明家庭BP监控（HBPM）是否可以代替ABPM来识别MH，如果是这样，它是否可以识别同样的高危人群。我们的目的是（1）评估MH的可重复性，并评估HBPM和ABPM在识别MH方面的一致性，（2）识别与MH相关的人口统计学，心理社会和临床因素，以及（3）探索与MH相关的目标器官损害和亚细胞衰弱的程度。为了实现这些目标，我们将在420名不接受12个初级保健实践招募的高血压治疗的成年人一周内进行两套办公室，ABPM和HBPM BP测量。其他措施将包括血清葡萄糖，脂质和C反应蛋白；尿白蛋白；左心室质量指数；冠状动脉钙；感知压力；工作和家庭压力；和特征角。研究小组在BP测量研究，对BP的心理社会影响，心脏成像方法，冠心病风险评估以及在初级保健实践网络中进行研究方面拥有丰富的经验。预计我们的研究将提高我们对MH的流行病学和含义的理解，并最终导致将提高对人群高BP的检测的策略。公共卫生相关性：办公室血压测量结果无法检测到数百万人的高血压的可能性，需要在拟议的研究中描述的那种严格的调查。这些发现有望导致临床策略，从而更加认识到高血压，因此最终导致人群心血管发病率和死亡率降低。