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

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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.