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.

 描述（由申请人提供）：本申请建议通过收集神经认知功能、内皮功能和脑血管储备的测量结果，扩展一项正在进行的、由 NHLBI 资助的针对难治性高血压患者的运动和饮食随机临床试验（难治性高血压生活方式改变的设施和网络方法；R01HL122836）。众所周知，高血压与脑血管不良后果（包括中风）的风险增加有关，并且是认知能力下降和痴呆的最重要的可改变危险因素。与血压正常者相比，高血压患者表现出神经认知障碍，以及微血管缺血性脑部变化。顽固性高血压（RH）患者（定义为尽管经过最佳药物治疗但血压（BP）控制不佳）与高血压得到控制的患者相比，出现不良临床事件和认知障碍的风险更高。运动和饮食已被证明可以降低血压并改善神经认知，为缓解认知障碍提供干预机会。然而，生活方式改变对 RH 患者神经认知的影响从未在 RH 患者中得到研究。 母体随机临床试验 (RCT) 旨在检查接受综合生活方式干预计划 (C-Life) 的 RH 个体与标准化教育和医生建议 (SEPA) 对照条件相比，血压、体重、健康和心血管生物标志物的变化。 C-Life 干预措施将包括有监督的有氧运动、遵循预防高血压饮食方法 (DASH) 饮食的饮食调整以及结构化减肥，而随机分配到 SEPA 的参与者将获得有关这些健康生活方式改变的信息，但不会参加强化的监督计划。本提案的目的是检查 C-Life 对神经认知表现的影响、神经认知改善的机制以及神经认知改善的维持。为了实现这一目标，我们将通过收集基线时的神经认知表现（执行功能、处理速度和记忆力）、内皮功能（肱动脉血流介导的扩张）和脑血管储备（前额皮质脑组织氧合指数）的多项指标来加强母研究，在4个月的干预之后，以及在一年的随访评估中，与母试验一起进行再次评估 评估。该研究旨在评估（a）C-Life 对改善神经认知功能的有效性，（b）C-Life 对内皮功能和脑血管储备生物标志物的影响，（c）神经认知功能治疗改善的潜在中介因素，包括健康、内皮功能、脑血管储备、血压降低和体重减轻的改善，以及（d）改善健康的效果， DASH 饮食依从性、体重减轻和血压降低对一年后神经认知功能的影响。