Neurocognition, Lifestyle Modification, and Treatment Resistant Hypertension

神经认知、生活方式改变和难治性高血压

• 批准号: 9007501
• 负责人: Patrick Josey Smith
• 金额: $ 21.9万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-01-01 至 2019-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9007501
• 关键词: Address; Adherence; Aerobic Exercise; Age; Antihypertensive Agents; Behavior Therapy; Biological Markers; Blood Pressure; Body Weight; Body Weight decreased; Brain; Caloric Restriction; Cardiovascular Diseases; Cardiovascular system; Cerebrovascular Disorders; Cerebrum; Clinical; Clinical Trials; DASH diet; Dementia; Development; Diet; Diet Modification; Diuretics; Dose; Education; Effectiveness; Elderly; Event; Exhibits; Funding; Habits; Health; Health Care Costs; Health Expenditures; Hypertension; Hypotension; Impaired cognition; Incidence; Individual; Intervention; Knowledge; Life; Life Style; Maintenance; Measures; Medial; Mediating; Mediator of activation protein; Memory; National Heart, Lung, and Blood Institute; Neurocognition; Neurocognitive; Neurocognitive Deficit; Obesity; Online Systems; Outcome; Overweight; Parents; Participant; Patients; Performance; Pharmaceutical Preparations; Pharmacological Treatment; Physicians; Population; Prefrontal Cortex; Prevalence; Public Health; Randomized; Randomized Clinical Trials; Research Infrastructure; Resistant Hypertension; Risk; Risk Factors; Stroke; Structure; Thick; Time; Vulnerable Populations; Weight; blood pressure reduction; blood pressure regulation; brachial artery; brain dysfunction; cardiovascular disorder risk; cerebrovascular; cost effective; design; diet and exercise; dietary approach; executive function; exercise adherence; experience; fitness; follow-up; healthy lifestyle; hemodynamics; high risk; hypertension control; improved; indexing; intervention program; lifestyle intervention; modifiable risk; normotensive; prevent; processing speed; programs; therapy design; tissue oxygenation

 DESCRIPTION (provided by applicant): The present application proposes to extend an ongoing, NHLBI-funded, randomized clinical trial of exercise and diet among individuals with resistant hypertension (Facilities and Web-based Approaches to Lifestyle Change in Resistant Hypertension; R01HL122836) by collecting measures of neurocognitive performance, endothelial function, and cerebrovascular reserve. It is well established that HTN is associated with increased risk of adverse cerebrovascular outcomes, including stroke, and is the most important modifiable risk factor for cognitive decline and dementia. Hypertensive patients exhibit neurocognitive impairments compared with normotensives, as well as microvascular ischemic brain changes. Patients with resistant hypertension (RH), defined as inadequately controlled blood pressure (BP) despite optimal pharmacological treatment, are at even higher risk of adverse clinical events and cognitive impairment compared to patients with controlled HTN. Exercise and diet have been shown to reduce BP and improve neurocognition, providing an intervention opportunity for the mitigation of cognitive impairment. However, the impact of lifestyle change on neurocognition has never been examined among patients with RH. The parent randomized clinical trial (RCT) is designed to examine changes in BP, weight, fitness, and cardiovascular biomarkers among individuals with RH undergoing a comprehensive lifestyle intervention program (C-Life) compared with standardized education and physician advice (SEPA) control condition. The C- Life intervention will consist of supervised aerobic exercise, dietary modification following the Dietary Approaches to Stop Hypertension (DASH) diet, and structured weight loss, whereas participants randomized to SEPA will be provided with information about these healthy lifestyle changes, but will not participate in the intensive, supervised program. The objective of the present proposal is to examine the effects of C-Life on neurocognitive performance, mechanisms of neurocognitive improvement, and maintenance of neurocognitive improvements. In order to accomplish this, we will enhance the parent study by collecting multiple measures of neurocognitive performance (executive function, processing speed, and memory), endothelial function (brachial artery flow mediated dilation), and cerebrovascular reserve (prefrontal cortex cerebral tissue oxygenation index) at baseline, following the 4-month intervention, and again during a one-year follow-up assessment, in tandem with parent trial assessments. The study will aim to evaluate (a) the effectiveness of C- Life on improving neurocognitive function, (b) the impact of C-Life on biomarkers of endothelial function and cerebrovascular reserve, (c) potential mediators of treatment improvements in neurocognitive function, including improvements in fitness, endothelial function, cerebrovascular reserve, BP reduction, and weight loss, and (d) the effects of improved fitness, DASH dietary adherence, reduced body weight, and BP reductions on neurocognitive performance at one-year.

 DESCRIPTION (provided by application): The present application proposals to extend an ongoing, NHLBI-funded, randomized clinical trial of exercise and diet among individuals with resistant hypertension (Facilities and Web-based Approaches to Lifestyle Change in Resistant Hypertension; R01HL122836) by collecting measures of neurocognitive performance, endothelial function, and cerebrovascular reserve.众所周知，HTN与包括中风在内的不良脑血管结局的风险增加有关，并且是认知能力下降和痴呆症的最重要的修改风险因素。高血压患者与正常的紧张感和微血管缺血性脑的变化相比，暴露于神经认知障碍。与受控HTN的患者相比，尽管药物治疗最佳，但具有抗性高血压（RH）的患者（RH）被定义为不充分控制的血压（BP），甚至具有更高的不良临床事件和认知障碍的风险。运动和饮食已被证明可以减少BP并改善神经认知，从而为缓解认知障碍提供了干预机会。但是，在RH患者中，从未对生活方式改变对神经认知的影响。父母随机临床试验（RCT）旨在检查RH患者中BP，体重，健身和心血管生物标志物的变化，与标准化的教育和身体建议（SEPA）控制条件相比，经历了全面的生活方式干预计划（C-LIFE）。 c-生命干预将包括监督有氧运动，饮食方法以停止高血压（DASH）饮食和结构性减肥的方法，而随机将随机分配给SEPA的参与者将获得有关这些健康生活方式改变的信息，但不会参与强化，受监督的计划。本提案的目的是检查C-生活对神经认知性能，神经认知改善的机制以及神经认知改善的影响。为了实现这一目标，我们将通过收集多种神经认知性能（执行功能，处理速度和记忆），内皮功能（臂动脉流介导的词典）和脑血管储备（在基线后的脑皮层氧气指数）中，在4-M-M-MESTENTER中进行4米的介绍，并在4-M-MESTENTION中，并再次在4-M-MESTERMENT中，并再次在4-M-M-MESTENT中，并再次介绍了4-元素，从而，我们将在4-米高的过程中，并在4-米型中进行脑血管储备，从而增强父母的研究。评估。 The study will aim to evaluate (a) the effectiveness of C-Life on improving neurocognitive function, (b) the impact of C-Life on biomarkers of endothelial function and cerebrovascular reserve, (c) potential mediators of treatment improvements in neurocognitive function, including improvements in fitness, endothelial function, cerebrovascular reserve, BP reduction, and weight loss, and (d) the effects of improved fitness,一年来，破折号饮食依从性，体重减轻以及BP降低了神经认知表现。