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Race / Ethncicity, Hypertension and Prevention of VCID and Stroke after Intracerebral Hemmorrhage

种族/民族、高血压以及 VCID 和脑出血后中风的预防

基本信息

批准号：
10677746
负责人：
JONATHAN ROSAND
金额：
$ 199.89万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-02-01 至 2027-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10677746
关键词：
Acceleration Acute Affect American Asian population Biological Factors Black Populations Black race Blood Pressure Brain Brain hemorrhage Caring Cerebral hemisphere hemorrhage Cerebral small vessel disease Clinical Clinical Trials Data Dementia Disparity Economically Deprived Population Enrollment Ethnic Origin Evidence based program Failure Funding Future Genetic Goals Health Services Accessibility Hispanic Hispanic Populations Hypertension Image Impaired cognition Individual Inequity Intervention Knowledge Life Mediating Medical Minority Groups Morbidity - disease rate Outcome Patients Persons Prevention Quality of life Race Recurrence Reporting Research Risk Role Rupture Shapes Social Network Social support Standardization Stroke Subgroup Survivors System Testing Time Vascular Cognitive Impairment blood pressure control blood pressure elevation blood pressure intervention blood pressure reduction burden of illness cohort community based participatory research design ethnic disparity experience functional decline health care availability health care disparity health disparity health inequalities health literacy healthspan high risk hypertension control improved improved outcome longitudinal course mortality multi-racial novel strategies patient engagement personalized intervention post stroke prevent programs racial disparity randomized trial recruit risk prediction social social health determinants socioeconomic disadvantage stroke survivor success vascular cognitive impairment and dementia

项目摘要

PROJECT SUMMARY Intracerebral hemorrhage (ICH) accounts for almost half of stroke-related morbidity and mortality. Among ICH survivors, nearly 2/3 will develop either incident cognitive decline, in the form of Vascular contributions to Cognitive Impairment and Dementia (VCID), or recurrent stroke within 5 years. This rapid functional decline, the result of progression of underlying Cerebral Small Vessel Disease (CSVD), is accelerated for Black and Hispanic ICH survivors, yielding a substantial health disparity. Arresting this progression therefore holds the promise of markedly improving outcomes for the >50,000 ICH survivors annually in the US and correcting a considerable health inequity. Elevated Blood Pressure (BP) is the most potent predictor of incident VCID and stroke after ICH. Yet >50% of ICH survivors have untreated hypertension after their ICH, with substantially higher rates among Black and Hispanic patients. Improving BP control following stroke remains a persistent challenge. Clinical trials of BP lowering programs have not demonstrated efficacy. A chief obstacle has been a failure to engage patients in the programs. Social determinants of health (SDOH), the wider set of forces and systems shaping daily life, contribute to risk for most medical conditions, and are key contributors to race/ethnic health inequities. Nonetheless, there have been no systematic studies of SDOH in ICH, leaving a crucial gap in knowledge. The overarching goal of the present renewal proposal, entitled Race / Ethnicity, Hypertension and Prevention of VCID and Stroke after ICH, is to build on the results of the soon-to-conclude Recurrent Hemorrhagic Stroke in Minority Populations (R01NS093870) study and fill gaps in the knowledge that is essential for informing the design of future interventions to enhance BP control and eliminate racial/ethnic inequities in VCID and recurrent stroke after ICH. The crucial next step is identifying potentially modifiable SDOH that have the highest impact on 1) post-ICH VCID and recurrent stroke; 2) rates of uncontrolled hypertension, and 3) engagement with strategies to lower BP. We will enroll and follow longitudinally 700 ICH survivors divided among Black, Hispanic, White, Asian individuals, all of whom will receive a standardized state-of-the-art evidence-based program of BP management. We seek to: 1) determine whether modifiable SDOH in association with established biological factors, predict increased risk for VCID and recurrent stroke after ICH; 2) determine whether modifiable SDOH predict risk of poor hypertension control after ICH; 3) determine whether modifiable SDOH are associated with decreased engagement with our standardized BP management program. The data generated will be used to develop novel strategies for BP management and prevention of VCID and recurrent stroke after ICH, and are likely to have implications for preventing CSVD-related VCID and stroke, even in those who have not suffered an ICH.

项目摘要脑出血（ICH）几乎占卒中相关发病率和死亡率的一半。在ICH中幸存者中，近2/3将发展为偶发性认知下降，以血管贡献的形式，认知障碍和痴呆（VCID），或5年内复发性卒中。这种快速的功能衰退，基础脑小血管疾病（CSVD）进展的结果，在黑人中加速，西班牙裔ICH幸存者，产生了显著的健康差异。因此，阻止这一进程将使有望显著改善美国每年> 50，000例ICH幸存者的结局，并纠正严重的健康不平等。血压升高（BP）是ICH后发生VCID和卒中的最有效预测因子。但>50% 脑出血幸存者在脑出血后患有未经治疗的高血压，黑人和西班牙裔患者改善中风后的血压控制仍然是一个持续的挑战。BP的临床试验降低的方案没有显示出有效性。一个主要的障碍是未能让病人参与到程序.健康的社会决定因素（SDOH），塑造日常生活的更广泛的力量和系统，导致大多数医疗条件的风险，是种族/民族健康不平等的关键因素。尽管如此，还没有对ICH中的SDOH进行系统研究，这在知识上留下了重要的空白。本更新提案的总体目标，题为种族/民族，高血压和预防， VCID和脑出血后卒中的研究，是建立在即将得出结论的复发性出血性卒中的结果之上的少数族裔群体（R 01 NS 093870）研究并填补对于告知少数族裔群体至关重要的知识空白设计未来的干预措施，以加强BP控制，消除VCID和复发性脑出血后中风关键的下一步是确定潜在的可修改的SDOH， 1)ICH后VCID和复发性卒中; 2）不受控制的高血压发生率; 3）参与策略降低BP。我们将招募并纵向随访700名ICH幸存者，分为黑人、西班牙裔、白色、亚洲人个人，所有这些人都将接受标准化的最先进的BP管理循证计划。我们试图：1）确定是否可修改的SDOH与既定的生物因素，预测 ICH后VCID和复发性卒中的风险增加; 2）确定可修改的SDOH是否可预测 ICH后高血压控制不佳; 3）确定可调整的SDOH是否与降低的参与我们的标准化BP管理计划。产生的数据将用于开发新的血压管理和预防VCID和ICH后复发性卒中的策略，这对预防CSVD相关的VCID和卒中具有重要意义，即使在那些没有发生ICH的患者中也是如此。