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

一生中较低血压对黑人、西班牙裔和白人晚年认知的影响 (BP-COG)

• 批准号: 10198048
• 负责人: Deborah Levine
• 金额: $ 71.89万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10198048
• 关键词: Adult; Affect; Age; Age of Onset; Alzheimer' s Disease; Alzheimer' s disease related dementia; American; Antihypertensive Agents; Automobile Driving; Benefits and Risks; Biological; Biological Factors; Blood Pressure; Blood Vessels; Brain; Cardiovascular Diseases; Cerebral small vessel disease; Chronic Disease; Clinical; Cognition; Cognitive; Cohort Studies; Computer Simulation; Data; Data Analyses; Dementia; Development; Elderly; Enrollment; Event; Goals; Hand; Health; Health Sciences; Health Services Research; Hispanics; Human; Hypertension; Impaired cognition; Individual; Intervention; Intervention Trial; Knowledge; Lead; Life Cycle Stages; Measures; Methods; Minority; Mission; Modeling; Outcome; Patient risk; Patients; Pharmaceutical Preparations; Policies; Population; Population Heterogeneity; Prevalence; Prevention; Prevention approach; Public Health; Research; Research Proposals; Risk; Risk Estimate; Risk Factors; Sample Size; Severities; Testing; Time; Translating; United States; United States National Institutes of Health; Vascular Diseases; White Matter Hyperintensity; Work; base; blood pressure intervention; blood pressure reduction; blood pressure regulation; burden of illness; cardiovascular disorder risk; clinical care; clinical decision-making; cohort; cost; dementia risk; demographic disparity; design; disability; disparity elimination; disparity reduction; effective therapy; ethnic difference; ethnic disparity; health disparity; improved; improved outcome; individualized medicine; innovation; middle age; models and simulation; personalized approach; population based; prevent; preventive intervention; racial and ethnic; racial and ethnic disparities; risk prediction model; sociodemographics; stroke risk; therapy design; treatment strategy; trial design; vascular risk factor; young adult

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.

项目总结/摘要 在了解血压（BP）控制的种族/民族差异如何影响RA方面存在根本性的差距。 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中的社会人口差异是设计旨在消除这些疾病的干预措施的关键障碍， 关系的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， 提供给不同的人群。本研究的目的是量化种族/民族差异对血压控制的影响， 控制CID中的种族/民族差异，以量化最佳BP治疗强度对降低种族/民族差异的潜在影响。 CID的社会/种族差异，并设计一个可行的BP干预试验，以减少CID或认知能力下降的风险。 CID是一种严重的慢性疾病的极好模型，在患病率和费用方面存在种族/民族差异。高血压是一种 理想的生物学风险因素，因为它可以通过广泛的有效治疗方法进行修改。我们的中央 假设是在整个生命过程中控制高血压的种族/民族差异有助于种族/民族差异， 晚年CID的奇偶校验拟议研究的基本原理是，了解BP中的种族/民族差异 从青年到晚年的控制有助于CID中的种族/民族差异，有可能转化为 有针对性的干预措施，旨在改善高血压的质量和结果，从而产生新的创新方法 预防CID和其他严重的慢性疾病不成比例地影响黑人和西班牙裔。 在强有力的初步数据的指导下，该假设将通过追求3个具体目标进行测试：1）确定影响 在黑人、西班牙裔和白人中，从青年期到晚年的较低血压水平对CID风险的影响; 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 试验的规模和持续时间，有足够的把握度来发现血压降低对临床上不明显的CID的效应量， 很重要。在目标1下，采用汇集队列研究的卫生服务研究方法在应用中显示是可行的， 将被用来测量血压水平的影响和使用抗高血压药物从年轻的成年人- 冒着刑事调查局的风险从兜帽到晚年根据目标2和3，模拟建模方法，这也被证明是可行的， 在申请人的手中，将被用来量化消除种族/民族差异的个人和社会影响， 从青年到晚年的血压控制对晚年CID中种族/民族差异的影响，并确定 BP干预试验的样本量和持续时间，以降低不同人群中CID或认知能力下降的风险。 这项研究提案是创新的，因为它包括年轻人和西班牙裔。不仅种族/民族差异 高血压对认知的影响似乎也开始年轻的成年期。 西班牙裔是一个研究不足的人群，有更大的风险比白人更差的血压控制和CID。这项研究将 通过纳入来自不同合作伙伴新的基于人群的风险估计，改进当前BP相关风险预测模型， 队列，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最佳BP治疗的个人和社会效益， CID的紧张程度，以告知临床护理和政策，并确定BP干预试验的样本量和持续时间， 降低CID的风险。这项拟议的研究意义重大，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 CID的差异，并改善降压试验的设计及其在不同人群中的应用。最后， 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和控制艾滋病毒/艾滋病。 预防CID和减少美国老年人特别是少数民族中与CID相关的残疾。