The Effect of Lower Blood Pressure over the Life Course on Late-life Cognition in Blacks, Hispanics, and Whites (BP-COG)

项目摘要/摘要 在了解种族/民族在血压控制方面的差异如何影响心率方面存在着根本性的差距。 认知障碍和痴呆症(CID)的社会/种族差异。对生物因素的认识不足 CID的社会人口差异是设计旨在消除这些差异的干预措施的关键障碍。 领带。这项研究的长期目标是开发、测试和传播预防CID的干预措施。 适用于不同的人群。这项研究的目的是量化种族/民族差异在BP疾病中的影响。 控制CID的种族/民族差异，以量化最佳BP治疗强度对降低Ra-Ra的潜在影响 研究CID的社会/种族差异，并设计一项可行的BP干预试验，以降低CID或认知功能下降的风险。 CID是一种严重的慢性病的极好模型，其发病率和费用存在种族/民族差异。高BP是一种 理想的生物风险因素，因为它可以通过一系列有效的治疗方法进行管理而改变。我们的中央 假说是，在整个生命过程中控制高血压的种族/民族差异导致种族/民族差异。 晚年CID中的生育情况。这项拟议研究的基本原理是理解英国石油公司的种族/民族差异 从青壮年到晚年的控制导致了CID中的种族/民族差异有可能转化为 旨在改善高血压的质量和结果的有针对性的干预措施，从而产生新的和创新的方法 用于预防CID和其他严重、慢性疾病，对黑人和西班牙裔的影响不成比例。 在强大的初步数据的指导下，这一假设将通过追求三个具体目标来检验：1)确定影响 黑人、西班牙裔和白人从年轻成年到晚年血压水平较低对CID风险的影响；以及2)估计 最佳BP治疗强度对减少CID中种族/民族差异的潜在影响；以及3)确定样本 一项试验的规模和持续时间，该试验有足够的动力来寻找降压对CID的影响大小，并且在临床上是有效的。 重要人物。在目标1下，采用汇集队列研究的保健服务研究方法--经证明在应用中是可行的-- Cants的手-将被用来测量血压水平和年轻人使用降压药的影响- 从胡德到晚年的CID风险。在目标2和目标3下，提出了一种仿真建模方法，该方法也被证明是可行的。 将用于量化消除种族/民族差异对个人和社会的影响- 从青壮年到晚年的BP控制对晚年CID的种族/民族差异的影响，并确定 BP干预试验的样本大小和持续时间，以降低不同组中CID或认知能力下降的风险。 这项研究提案具有创新性，因为它包括了年轻人和拉美裔美国人。不仅种族/民族差异 血压控制在青年时期就开始了，但高血压对认知的影响似乎也在青年时期就开始了。 拉美裔是一个研究不足的群体，与白人相比，他们更有可能出现更糟糕的BP控制和CID。这项研究将 通过整合来自不同合作伙伴的新的基于人群的风险估计来改进当前的BP相关风险预测模型 Horts，并将CID作为BP相关结果添加到现有的心血管疾病计算机模拟模型中。这 CID增强的计算机模拟模型将估计在以下情况下最佳BP治疗的个人和社会利益 CID的紧张度，为临床护理和政策提供信息，并确定BP干预试验的样本量和持续时间 降低CID的风险。拟议的研究具有重要意义，因为它将产生所需的新知识和方法 了解生命过程中最佳BP治疗强度的种族/民族差异对种族/民族的影响 旨在改善慢性阻塞性肺疾病患者的血压差异，并改进降压试验的设计及其在不同人群中的应用。最终， 这种知识有可能为制定有针对性的干预措施提供信息，这将有助于改善 预防CID，并减少老年美国人，特别是少数族裔中与CID相关的残疾。

Project Summary/Abstract There is a fundamental gap in understanding how racial/ethnic differences in blood pressure (BP) control influence ra- cial/ethnic disparities in cognitive impairment and dementia (CID). Poor understanding of the biological factors driving socio-demographic disparities in CID is a critical barrier to the design of interventions aimed to eliminate these dispari- ties. The long-term goal of this research is to develop, test, and disseminate interventions that prevent CID and can be ap- plied to diverse populations. The objectives of this study are to quantify the effects of racial/ethnic differences in BP con- trol on racial/ethnic differences in CID, to quantify the potential impact of optimal BP treatment intensity to reduce ra- cial/ethnic disparities in CID, and to design a feasible BP intervention trial to reduce the risk of CID or cognitive decline. CID is an excellent model of a serious, chronic illness with racial/ethnic disparities in prevalence and costs. High BP is an ideal biological risk factor because it is modifiable with a wide range of effective therapies for management. Our central hypothesis is that racial/ethnic differences in the control of high BP across the life course contribute to racial/ethnic dis- parities in late-life CID. The rationale for the proposed research is that understanding how racial/ethnic differences in BP control from young adulthood to late-life contribute to racial/ethnic disparities in CID has the potential to translate into targeted interventions aimed to improve the quality and outcomes of high BP, resulting in new and innovative approaches to the prevention of CID and other serious, chronic illnesses disproportionately affecting Blacks and Hispanics. Guided by strong preliminary data, this hypothesis will be tested by pursuing 3 specific aims: 1) Determine the influence of lower BP levels from young adulthood to late-life on CID risk in Blacks, Hispanics, and Whites; and 2) Estimate the potential impact of optimal BP treatment intensity to reduce racial/ethnic disparities in CID; and 3) Determine the sample size and duration of a trial that is adequately powered to find an effect size of BP lowering on CID that is clinically im- portant. Under Aim 1, a health services research approach with pooled cohort studies—shown to be feasible in the appli- cants' hands—will be used to measure the effects of BP levels and use of antihypertensive medication from young adult- hood to late-life on CID risk. Under Aims 2 and 3, a simulation modeling approach, which also has been proven as feasi- ble in the applicants' hands, will be used to quantify the individual and societal effects of eliminating racial/ethnic differ- ences in BP control from young adulthood to late-life on racial/ethnic disparities in late-life CID, and to determine the sample size and duration of a BP intervention trial to reduce the risk of CID or cognitive decline in diverse groups. This research proposal is innovative because it includes young adults and Hispanics. Not only do racial/ethnic disparities in BP control begin in young adulthood, but the effect of high BP on cognition also appears to begin in young adulthood. Hispanics are an understudied population that has greater risk of worse BP control and CID than Whites. The study will improve current BP-related risk prediction models by incorporating new population-based risk estimates from diverse co- horts and by adding CID as a BP-related outcome to an existing cardiovascular disease computer simulation model. This CID-enhanced computer simulation model will estimate the individual and societal benefits of optimal BP treatment in- tensity on CID to inform clinical care and policy and determine the sample size and duration of a BP intervention trial to reduce the risk of CID. The proposed study is significant because it will generate new knowledge and methods needed to understand the impact of racial/ethnic differences in optimal BP treatment intensity over the life course on racial/ethnic disparities in CID and to improve the design of BP lowering trials and their application to diverse populations. Ultimately, such knowledge has the potential to inform the development of targeted interventions that will help to improve the pre- vention of CID and to reduce CID-related disability in older Americans particularly minorities.