Home blood pressure and falls among older adults

心血管疾病（CVD）是美国老年人死亡的主要原因。超过75%的美国成年人≥ 65岁以上的人患有高血压，这是CVD的主要危险因素。随机对照试验 研究表明，通过抗高血压药物降低血压（BP）可降低心血管疾病的风险 在老年高血压患者中减少了20%到40%。许多美国老年人血压不受控制， 从强化抗高血压药物治疗中获得降低心血管疾病风险的益处。然而，临床医生 他们经常担心，大幅降低BP可能会增加下跌的风险。福尔斯是导致 美国老年人和超过三分之一≥ 65岁的美国成年人中的损伤相关住院和死亡 年的年龄经历每年下降。BP传统上是在临床环境中测量的， 临床医生在决定滴定抗高血压药物时遇到的挑战是血压的不准确性 在这种情况下评估。家庭血压监测（HBPM）是一种廉价且高度可行的方法。 在临床环境外测量血压的方法，有可能改善血压控制， 降低CVD风险。HBPM是否可以识别可以使用抗高血压药物的患者 在不增加跌倒风险的情况下加强是未知的。新NIH资助（2018年7月1日至2022年6月30日） 前瞻性队列研究（老年人血压监测[安博社]）将评估 使用动态血压监测（ABPM）在诊所外测量的BP， 在1，057名年龄≥ 65岁的成人中，有福尔斯风险，服用Kaiser的降压药物 永久南加州（KPSC）卫生系统。选择ABPM用于Ambrosia研究，因为它是 被认为是评估门诊BP的金标准方法。与ABPM相比，HBPM更 在美国广泛使用，患者耐受性更好。安布罗西亚研究没有资金进行 HBPM。拟议的安布罗西亚辅助研究的总体目标是确定BP是否使用HBPM 可以识别服用抗高血压药物的老年人，他们福尔斯的风险增加， 与ABPM相比，HBPM对福尔斯的预测值相似。安博亚太将开始研究访视 2019年2月，拟议的辅助研究（AMBROSIA-HOME）将增加HBPM的实施， 每天，在早晨获得两次BP测量，在晚上获得两次BP测量 每天，在对1，000名参与者进行ABPM后。开展安布罗西亚-HOME研究 将具有成本效益，因为人口统计学和临床特征、老年评估 研究级BP测量，24小时ABPM已经在基线时收集了福尔斯， 在一年的随访期内评估严重的跌倒伤害。安布罗西亚-HOME研究将 提供关于HBPM对服用抗高血压药物的老年人进行个性化护理的作用的有价值的数据 药

Cardiovascular disease (CVD) is the leading cause of death among older US adults. Over 75% of US adults ≥ 65 years of age have hypertension, a major risk factor for CVD. Randomized controlled trials have demonstrated that lowering blood pressure (BP) through antihypertensive medication reduces the risk for CVD by 20% to 40% among older adults with hypertension. Many older US adults have uncontrolled BP and may receive CVD risk reduction benefits from intensifying their antihypertensive medication. However, clinicians are often concerned that intensively lowering BP may increase the risk for a fall. Falls are the leading cause of injury-related hospitalization and death among older US adults and more than one in three US adults ≥ 65 years of age experience a fall each year. BP has traditionally been measured in the clinic setting and a major challenge that clinicians encounter in deciding to titrate antihypertensive medication is the inaccuracy of BP assessed in this setting. Home blood pressure monitoring (HBPM) is an inexpensive and highly feasible approach to measure BP outside of the clinic setting and has the potential to improve BP control and, therefore, reduce CVD risk. Whether HBPM can identify patients for whom antihypertensive medication can be intensified without increasing the risk for a fall is unknown. A newly NIH-funded (July 1, 2018 to June 30, 2022) prospective cohort study (AMBulatoRy blOod preSsure In older Adults [AMBROSIA]) will evaluate the association of BP, measured outside of the clinic setting using ambulatory blood pressure monitoring (ABPM), with falls risk among 1,057 adults aged ≥ 65 years, taking antihypertensive medication from the Kaiser Permanente Southern California (KPSC) health system. ABPM was chosen for the AMBROSIA study as it is considered the gold-standard approach for assessing out-of-clinic BP. Compared to ABPM, HBPM is more widely available in the US and better tolerated by patients. The AMBROSIA study is not funded to perform HBPM. The overall goal of the proposed ancillary study to AMBROSIA is to determine whether BP on HBPM can identify older adults taking antihypertensive medication who are at increased risk for falls, and whether HBPM provides similar predictive value for falls when compared with ABPM. AMBROSIA will begin study visits in February 2019 and the proposed ancillary study (AMBROSIA-HOME) will add the conduct of HBPM for 7 days, with two BP measurements obtained in the morning and two BP measurements obtained in the evening on each day, following the conduct of ABPM for 1,000 participants. Conducting the AMBROSIA-HOME study will be cost-efficient as information on demographic and clinical characteristics, geriatric assessments, research-grade BP measurements, and 24-hour ABPM is already being collected at baseline with falls and serious fall injuries being assessed during a one-year follow-up period. The AMBROSIA-HOME study will provide valuable data on the role of HBPM to personalize care for older adults taking antihypertensive medication.