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.

项目摘要/摘要 了解血压（BP）控制的种族/种族差异如何影响RA-存在根本的差距 认知障碍和痴呆症（CID）的cial/族裔差异。对驱动生物学因素的了解不足 CID中的社会人口统计学差异是旨在消除这些差异的干预措施设计的关键障碍 - 关系。这项研究的长期目标是开发，测试和传播干预措施，以防止CID，并且可以是 专注于潜水员人口。这项研究的目的是量化BP的种族/种族差异的影响 在CID中对种族/种族差异的trol，以量化最佳BP治疗强度的潜在影响以降低RA- CID中的CIAL/族裔差异，并设计可行的BP干预试验，以降低CID或认知能力下降的风险。 CID是一种严重，慢性病的出色模型，在患病率和成本方面具有种族/种族差异。高bp是一个 理想的生物风险因素，因为它可以通过多种有效的管理疗法进行修改。我们的中心 假设是，在整个生活课程中控制高BP的种族/种族差异有助于种族/种族疾病 晚年CID的平等。拟议研究的理由是了解BP的种族/种族差异 从成年到晚年的控制有助于CID中的种族/种族差异 有针对性的干预措施旨在提高BP的质量和结果，从而实现新的和创新的方法 预防CID和其他严重的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，该假设将通过追求3个具体目标来检验：1）确定影响 从成年年轻到晚年的BP水平较低，因为黑人，西班牙裔和白人的CID风险； 2）估计 最佳BP治疗强度的潜在影响减少CID中种族/种族差异的潜在影响； 3）确定样本 试验的大小和持续时间充分有能力找到BP降低对CID的影响大小 便携的。在AIM 1下，采用合并队列研究的卫生服务研究方法 - 在应用程序中是可行的 罐头的手 - 将用于衡量BP水平的影响和使用年轻成人的降压药的使用 引擎盖到CID风险后期。根据AIM 2和3，一种模拟建模方法，也已被证明是可行的 在申请人的手中，将用于量化消除种族/种族不同的个人和社会影响 在BP控制中，从成年到后期的年轻人中，在晚年CID中的种族/种族差异，并确定 BP干预试验的样本量和持续时间，以降低潜水员组CID或认知下降的风险。 这项研究建议具有创新性，因为它包括年轻人和西班牙裔。不仅造成ratic/族裔差异 在BP的控制始于成年期，但是高BP对认知的影响似乎也始于成年。 西班牙裔人是一个被理解的人群，比白人患BP控制和CID的风险更高。研究将 通过合并潜水员共同的新的基于人群的风险估计来改善当前与BP相关的风险预测模型 通过将CID作为BP相关的结果添加到现有的心血管疾病计算机模拟模型中。这 CID增强的计算机仿真模型将估计最佳BP治疗的个人和社会益处 CID上的张力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。拟议的研究很重要，因为它将产生新的知识和方法 了解种族/种族差异在最佳BP治疗强度对生活课程中对种族/种族的影响 CID的差异并改善BP降低试验的设计及其在潜水员人群中的应用。最终， 这种知识有可能告知有针对性干预措施的发展，这将有助于改善前 在美国年轻人特别是少数民族中，CID的出现并减少与CID相关的残疾。