Ambulatory BP, kidney function, cognitive & physical function in older adults

动态血压、肾功能、认知

• 批准号: 8093647
• 负责人: Dena Evette Rifkin
• 金额: $ 18.04万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8093647
• 关键词: Adherence; Adult; African American; Age; Age-Years; Aging; Albuminuria; Asians; Attitude; Award; Behavior; Belief; Biological; Blood Pressure; Cardiovascular Diseases; Cardiovascular system; Caring; Clinic; Cognitive; Communities; Comorbidity; Complex; Data; Development; Development Plans; Diabetes Mellitus; Disease; Disease Marker; Elderly; Epidemiology; Fellowship; Functional disorder; Geriatrics; Glomerular Filtration Rate; Goals; Grant; Health Services; Health Services for the Aged; Hispanics; Hour; Hypertension; Hypotension; Impaired cognition; Individual; Institution; Interview; K-Series Research Career Programs; Kidney Diseases; Knowledge; Laboratories; Link; Literature; Measurement; Measures; Mentorship; Nephrology; Obesity; Outcome; Patient Recruitments; Patient Self-Report; Patients; Pattern; Performance; Peripheral arterial disease; Pharmaceutical Preparations; Physical Function; Population; Pulse Pressure; Questionnaires; Recording of previous events; Renal function; Research; Research Personnel; Risk; Risk Factors; Surveys; Training; Ursidae Family; Vascular Diseases; arterial stiffness; base; cardiovascular disorder epidemiology; cardiovascular risk factor; career development; clinical care; cognitive function; cohort; community living; falls; frailty; hypertension control; hypertension treatment; indexing; interest; medication compliance; meetings; nephrogenesis; patient oriented research; skills; trait

DESCRIPTION (provided by applicant): Candidate and career development plan summary. Dr. Rifkin is a nephrologist with a strong interest in the care of older adults. She has a background in epidemiology and during fellowship training in nephrology studied the implications of abnormal kidney function for aging and cardiovascular disease in older adults. During the proposed career development award she plans to explore issues of hypertension, aging, kidney function, and cognitive and physical dysfunction in a cohort of community-dwelling older adults. She also plans to study barriers to appropriate medication use among a subset of the cohort who have both hypertension and kidney disease. She plans to develop her skills in patient recruitment, epidemiology, geriatrics, and health services during the term of the award and develop into an independent researcher in patient-oriented studies of older adults with kidney disease. Dr Rifkin's mentorship team for this grant includes experts in cardiovascular epidemiology, nephrology, hypertension, and geriatrics as well as biostatics and health services. Along with regular meetings with this group, Dr. Rifkin intends to pursue formal coursework in epidemiology, health services, hypertension and geriatrics both at local institutions and at national meetings during the course of the award. Research Plan summary. Older adults overwhelmingly bear the burden of hypertension and kidney disease, conditions that are strongly associated with CVD and physical and cognitive decline. Yet older individuals and those with comorbidities such as kidney disease are amongst those most likely to have poorly controlled hypertension, due to a complex and poorly understood constellation of barriers. Furthermore, 'hypertension' in older adults is a dynamic phenomenon that varies from moment to moment and throughout the day and night. Abnormal 24- hour ambulatory blood pressure (ABPM) patterns, in particular loss of the normal pattern of lower blood pressure at night, have been well-studied in the cardiovascular literature and are more closely linked to CVD outcomes than office blood pressure measurements, but data on associations of other abnormal ABPM patterns (pulse pressure variability, hypotension, and arterial stiffness indices) with kidney disease, cognitive, and physical dysfunction in contemporary multiethnic elders are lacking. A better understanding of these associations would inform hypertension treatment goals for older adults. The objective of this proposal is to obtain ABPM measurements and serial assessments of kidney function, physical function, and cognitive performance in a well-characterized population of 400 community-dwelling white, African-American, Hispanic, and Asian adults over 60 years of age. We will evaluate associations between ABPM pattern and kidney disease markers in this diverse cohort of older adults, investigate whether ABPM pattern is independently associated with unsuccessful aging (cognitive dysfunction, physical dysfunction, falls, and frailty) in this population, and assess longitudinal associations of ABPM with decline in kidney function and development of unsuccessful aging. Finally, we will explore the attitudes and knowledge about kidney disease and hypertension and the medication use patterns among a subset of the cohort and build a medication adherence and knowledge questionnaire directed at older adults with CKD. PUBLIC HEALTH RELEVANCE: Older adults overwhelmingly bear the burden of hypertension and kidney disease, undertreated diseases that are strongly associated with cardiovascular disease and physical and cognitive decline. Blood pressure varies throughout the day and night, and abnormal patterns of blood pressure have been associated with cardiovascular disease, but the effects of these patterns on kidney disease, physical function, and cognitive function in older adults are unclear. The objective of this proposal is to 1) assess the associations between 24- hour blood pressure recordings and kidney function, physical function, and cognitive performance in 400 community-dwelling white, African-American, Hispanic, and Asian adults over 60 years of age and to 2) determine the treatment barriers to clinical care for hypertension and kidney disease in these older adults.

描述（由申请人提供）：候选人和职业发展计划摘要。 里夫金（Rifkin）博士是一名对老年人护理的肾脏科医生。她具有流行病学的背景，在肾脏学研究金培训期间，她研究了异常肾功能对老年人衰老和心血管疾病的影响。在拟议的职业发展奖期间，她计划探索一系列社区居住的老年人的高血压，衰老，肾功能以及认知和身体功能障碍的问题。她还计划研究患有高血压和肾脏疾病的队列中适当使用药物使用的障碍。她计划在奖励期间发展自己的患者招聘，流行病学，老年医学和卫生服务的技能，并发展成为针对肾脏疾病老年人的患者研究的独立研究人员。 Rifkin博士的这项赠款的指导团队包括心血管流行病学，肾脏学，高血压和老年医学专家，以及生物统计学和卫生服务。 Rifkin博士在与该小组的定期会议上，打算在当地机构以及奖项期间在当地机构和全国会议上攻读流行病学，卫生服务，高血压和老年医学课程的正式课程。研究计划摘要。 老年人压倒性地承受着高血压和肾脏疾病的负担，与CVD以及身体和认知能力下降密切相关。然而，由于障碍的复杂且知识渊博，年龄较大的人和患有肾脏疾病等合并症的人（例如肾脏疾病）受到了控制的高血压。此外，老年人中的“高血压”是一种动态现象，在瞬间和整个黑夜中都会变化。异常的24小时卧床血压（ABPM）模式，特别是夜间降低血压的正常模式的丧失，在心血管文献中已得到充分研究，并且与CVD结局更紧密地联系在一起，而不是办公室血压测量值，而不是其他异常的ABPM型（脉动变化性）的相关性数据缺乏当代多民族长老的功能障碍。更好地了解这些关联将为老年人提供高血压治疗目标。 该提案的目的是获得ABPM的测量和串行评估，对肾脏功能，身体功能和认知表现的串行评估，包括400个社区居住的白人，非裔美国人，西班牙裔和60岁以上的亚洲成年人。我们将评估ABPM模式与肾脏疾病标志物之间的关联，并研究ABPM模式是否与失败的衰老（认知功能障碍，身体功能障碍，跌倒和脆弱）在此人群中是否独立相关，并在该人群中与ABPM的长期关联在不断衰落的范围内。最后，我们将探讨有关肾脏疾病和高血压的态度和知识，以及在同一组的子集中使用药物使用模式，并建立针对CKD老年人的药物依从性和知识问卷。 公共卫生相关性：老年人压倒性地承受着高血压和肾脏疾病的负担，与心血管疾病以及身体和认知能力下降密切相关的疾病不足。血压在整个白天和晚上都有不同，血压异常模式与心血管疾病有关，但是这些模式对肾脏疾病，身体机能和老年人的认知功能的影响尚不清楚。该提案的目的是1）评估400名居住在社区的白人，非洲裔美国人，西班牙裔和亚洲成年人60岁以上和2岁的亚洲成年人的24小时血压记录与肾脏功能，身体机能和认知表现之间的关联，并确定这些老年人的临床护理和肾脏疾病的治疗障碍。