Psychosocial Factors and Aging: Resting/Reflexive Cardiovascular Control

心理社会因素和衰老：静息/反射性心血管控制

• 批准号: 8532602
• 负责人: Richard P SLOAN
• 金额: $ 21.99万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-15 至 2015-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8532602
• 关键词: Affective; Age; Aging; Atherosclerosis; Autonomic nervous system; Baroreflex; Behavioral; Biological Markers; Blood Pressure; Cardiac; Cardiovascular system; Clinic; Clinical; Communities; Consensus; Data; Data Collection; Development; Diagnosis; Entropy; Frequencies; Health; Heart Rate; Heart failure; Hour; Hypertension; Inflammatory; Link; Measurement; Measures; Methods; Morbidity - disease rate; Myocardial Infarction; Noise; Organ; Participant; Patients; Periodicity; Physiological; Physiology; Positioning Attribute; Psychosocial Factor; Recovery; Research; Rest; Risk; Sampling; Series; Testing; Therapeutic Intervention; Time; Transplant Recipients; Variant; adverse outcome; autonomic reflex; base; cardiovascular risk factor; clinically significant; community health study; contextual factors; follow-up; heart rate variability; indexing; insight; middle age; mortality; novel; pressure; prognostic; prospective; psychologic; psychosocial; public health relevance; response

DESCRIPTION (provided by applicant): For decades, we have known that lower heart rate (HR) is associated with reduced morbidity and mortality. But HR is not stable - it is inherently "noisy," oscillating around the mean. Beginning in the 1980s, the clinical and physiological significance of these oscillations, now known as Heart Rate Variability (HRV), has been recognized. HRV predicts adverse outcomes following myocardial infarction or diagnosis of heart failure, progression of atherosclerosis in CAD patients, and the development of CAD in healthy community samples. Thus, measurement "noise" in HR is now recognized as a valuable index of cardiovascular health. Today, blood pressure (BP) is in a similar position as HR was 40 years ago. While the clinical significance of mean blood pressure (BP) has been accepted for decades, within-subject BP varies considerably across multiple time scales. Once dismissed as noise, BP variability (BPV) now also is thought to contain valuable information. Measured repeatedly over weeks or even years, the standard deviation (SD) of clinic-to-clinic BP predicted the development of hypertension and mortality after 12-14 years follow-up. On a 24-hour scale, the SD of BP measured every 30 min was associated with cardiovascular mortality after 8.5 years follow-up and with greater target organ damage. At a still shorter time scale, BP varies on a beat-to-beat basis. Consensus in the field is that the ultimate prognostic value of BPV may require analysis of these beat-to-beat BP oscillations. However, because measurement of these more rapid oscillations has been technically demanding, associations of beat-to-beat BPV with clinical or with psychosocial variables linked to health have not been established. Technological advances have made beat-to-beat BPV increasingly available and exploration of its relationship to cardiovascular health and contextual sociodemographic and psychosocial cardiovascular risk factors has the potential to yield important clinical and physiological insights. Measuring beat-to-beat BP along with RR intervals also allows for computation of baroreflex sensitivity (BRS), the relationship of reflexive changes in RR interval to changes in BP. While BPV may represent a tonic autonomic index, BRS is an index of autonomic reflexes that predicts adverse outcomes after MI and in heart failure. However, to our knowledge, community studies of BPV and BRS do not exist. We propose to analyze the beat-to-beat BP data already collected but not analyzed from participants at rest and in response to psychological and orthostatic challenge from the wave 2 of data collection in the Midlife in the US (MIDUS II) study. Our aims in this R21 are to examine relationships between resting and reactive BPV and BRS and psychosocial and biomarker data across the age spectrum and in an exploratory prospective analysis, to test whether greater BPV and lower BRS are associated with greater mortality.

描述（由申请人提供）：几十年来，我们已经知道较低的心率（HR）与降低发病率和死亡率有关。但人力资源并不稳定——它本质上是“嘈杂的”，在平均值周围振荡。从20世纪80年代开始，这些振荡的临床和生理意义，现在被称为心率变异性（HRV），已经被认识到。HRV可预测心肌梗死或心衰诊断后的不良后果、冠心病患者动脉粥样硬化的进展以及健康社区样本中冠心病的发展。因此，测量HR中的“噪声”现在被认为是心血管健康的一个有价值的指标。今天，血压（BP）与40年前的人力资源状况相似。虽然平均血压（BP）的临床意义已经被接受了几十年，但受试者内部的血压在多个时间尺度上差异很大。BP变异性（BPV）曾经被认为是噪音，现在也被认为包含有价值的信息。在数周甚至数年内反复测量，临床间血压的标准差（SD）预测了随访12-14年后高血压的发展和死亡率。在24小时范围内，每30分钟测量一次的血压SD与8.5年随访后的心血管死亡率和更大的靶器官损伤相关。在更短的时间尺度上，血压在搏动的基础上变化。该领域的共识是，BPV的最终预后价值可能需要分析这些搏动之间的血压振荡。然而，由于测量这些更快速的振荡在技术上要求很高，因此尚未确定搏动bpm与临床或与健康相关的社会心理变量之间的关联。技术进步已使心跳加速越来越容易获得，探索其与心血管健康以及相关社会人口和心理社会心血管风险因素的关系有可能产生重要的临床和生理学见解。测量心跳到心跳的血压和心率间隔也可以计算血压反射敏感性（BRS），即心率间隔的反射性变化与血压变化的关系。虽然BPV可能代表一种强直性自主神经指数，但BRS是一种自主神经反射指数，可预测心肌梗死和心力衰竭后的不良后果。然而，据我们所知，目前还没有关于BPV和BRS的社区研究。我们建议分析已收集但未分析的参与者在休息时的搏动血压数据，以及来自美国中年研究（MIDUS II）第二波数据收集的心理和直立性挑战。本R21的目的是研究静息性和反应性BPV与BRS之间的关系，以及跨年龄谱的社会心理和生物标志物数据，并通过探索性前瞻性分析来检验BPV越大、BRS越低是否与死亡率越高有关。