Exercise as an adjunct therapy to reduce blood pressure in Chronic Kidney Disease

运动作为降低慢性肾脏病血压的辅助疗法

• 批准号: 8425358
• 负责人: Ulf G Bronas
• 金额: $ 6.85万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8425358
• 关键词: Aerobic Exercise; Affect; Angiotensins; Bioavailable; Biological Markers; Blood Pressure; Blood Vessels; Cardiovascular Diseases; Caring; Chronic Kidney Failure; Control Groups; Data; Diabetes Mellitus; Drops; Endothelin-1; Exercise; Funding; Future; Goals; Hour; Hypertension; Hypotension; Individual; Intervention; Investigation; Kidney Diseases; Medical; Nitric Oxide; Nitric Oxide Synthase; Outcome; Participant; Patients; Peripheral Resistance; Physical therapy exercises; Physiological; Pilot Projects; Population; Randomized; Randomized Controlled Trials; Relative (related person); Research; Research Personnel; Rest; Staging; Testing; Therapeutic; Therapeutic Intervention; Training; Vasoconstrictor Agents; Work; base; blood pressure regulation; clinical practice; design; diabetic; dimethylarginine; experience; improved; inhibitor/antagonist; insight; non-diabetic; novel; programs; public health relevance; response

DESCRIPTION (provided by applicant): Chronic kidney disease (CKD) affects more than 26 million individuals (13% of the U.S. population), and is projected to increase 70%, to over 40 million individuals by the year 2015. Inadequate blood pressure control is a major factor in the progression of CKD. Exercise is a potential adjunct therapy to reduce blood pressure in CKD patients. However, no large randomized, controlled trials specifically designed to investigate resting and 24-hr blood pressure levels in response to exercise training have been completed, and results of small, non- randomized studies have been mixed. The PI's (Dr. Bronas) current investigation (K23) on the cardioprotective effects of aerobic exercise in stage 2-4 diabetic CKD indicates significant exercise-induced reductions in mean resting blood pressure levels of 11.8 mm Hg systolic and 5.6 mm Hg diastolic (preliminary data, n=31). However, it is unknown if patients with non-diabetic CKD will experience a similar benefit. The proposed study will expand the scope of the PI's current research program and allow us to conduct the first randomized, controlled trial specifically designed to investigate the effect of regular aerobic exercise on resting and 24-hr blood pressure levels in patients with stage 3-4 CKD and hypertension. By expanding the scope of the current research we will be able to compare the blood-pressure reducing effect of exercise in the two major CKD populations that may benefit the most from exercise therapy. The objective of the proposed pilot study is therefore to test the hypothesis that regular aerobic exercise will lower resting and 24-hour ambulatory blood pressure levels in stage 3-4 non-diabetic CKD patients with hypertension. We will achieve this objective by randomizing 40 patients with stage 3-4 non-diabetic CKD with hypertension to either 12 weeks of aerobic exercise training (n=20) or usual medical care (n=20). In addition, we will determine the effect of 12 weeks of exercise training on effective vascular compliance and biomarkers associated with blood pressure regulation, and their association with exercise-induced changes in blood pressure levels. This study will generate new hypotheses regarding the impact of exercise therapy on factors associated with blood pressure regulation in patients with CKD-hypertension and provide insight into new and adjunctive treatment options. The expected outcomes of the work proposed is to further our understanding of the benefit of regular exercise on blood pressure control in patients with CKD and provide insight into the relative physiological responses to exercise in patients with non-diabetic CKD or diabetic CKD. Moreover, this study will directly enhance Dr. Bronas research capability as he is completing his transition to fully independent investigator status and allow him to quickly move into independent R01 funding.

描述（由申请人提供）：慢性肾脏疾病（CKD）影响超过2600万人（占美国人口的13%），预计到2015年将增加70%，超过4000万人。血压控制不佳是CKD进展的主要因素。运动是降低CKD患者血压的潜在辅助疗法。然而，还没有专门设计的大型随机对照试验来研究运动训练对静息和24小时血压水平的影响，小型非随机研究的结果也不一致。PI（Dr. Bronas）目前对有氧运动对2-4期糖尿病CKD的心脏保护作用的研究（K23）表明，运动诱导的平均静息血压水平显著降低，收缩压为11.8 mm Hg，舒张压为5.6 mm Hg（初步数据，n=31）。然而，目前尚不清楚非糖尿病肾病患者是否会经历类似的益处。拟议的研究将扩大PI当前研究计划的范围，并使我们能够进行第一项专门设计的随机对照试验，以研究规律有氧运动对3-4期CKD和高血压患者的静息和24小时血压水平的影响。通过扩大目前研究的范围，我们将能够比较运动在两个主要CKD人群中的降压效果，这两个人群可能从运动疗法中获益最多。因此，拟议的初步研究的目的是检验以下假设：定期有氧运动将降低3-4期非糖尿病CKD伴高血压患者的静息和24小时动态血压水平。我们将通过将40例3-4期非糖尿病CKD伴高血压患者随机分配至12周有氧运动训练组（n=20）或常规医疗护理组（n=20）来实现这一目标。此外，我们将确定12周运动训练对有效血管顺应性和与血压调节相关的生物标志物的影响，以及它们与运动诱导的血压水平变化的关系。这项研究将产生新的假设，运动疗法的影响与CKD高血压患者的血压调节相关的因素，并提供深入了解新的和连续的治疗方案。这项工作的预期结果是进一步了解定期运动对CKD患者血压控制的益处，并深入了解非糖尿病CKD或糖尿病CKD患者对运动的相对生理反应。此外，这项研究将直接增强Bronas博士的研究能力，因为他正在完成向完全独立研究者身份的过渡，并使他能够迅速进入独立的R 01资助。