A New Paradigm for Hypertension in the Elderly- Beyond Age

老年人高血压的新范式——超越年龄

基本信息

项目摘要

DESCRIPTION (provided by applicant): Over 60% of adults age � 65 years have high blood pressure (BP), but optimal management of high BP in the elderly remains controversial. Contrary to evidence in middle age that lowering BP is clearly beneficial, data in older adults are inconsistent and high BP may not be a risk factor in all elders. We recently reported that, among participants in the National Health and Nutrition Examination Survey age e65 years, high BP was a risk factor for all-cause and cardiovascular (CV) death only among persons in better health status (defined as fast walking of a 20-ft walk test). In contrast, high BP was not a risk factor among slow walkers. Additionally, the benefit of lowering BP in all elders remains an issue of debate; a recent meta-analysis in persons age 80 years and older reported no benefit of BP treatment on mortality, and significant heterogeneity across trials. Finally, there is growin concern for potential harms associated with treatment to lower BP. Excessive lowering of BP, particularly diastolic, has been associated with increased risk for death and cardiovascular events in some studies. In the proposed research, we propose a novel paradigm where the associations of BP with adverse outcomes in older persons are considered in the setting of the complex aging process. Our long-term goal is to reliably identify elderly persons in whom BP treatment is beneficial and those in whom treatment is ineffective or even harmful, by defining subpopulations of similar health status. Specifically, aim 1 proposes to elucidate factors from four domains (functional, cognitive/mental, self-rated health, and physiologic) that can identify elderly persons in whom high systolic BP is strongly associated with higher risk for death and CV events, and those in whom it is not, using data from three NIH-funded cohorts: Cardiovascular Health Study (CHS), Health Aging and Body Composition (Health ABC) and Sacramento Area Latino Study of Aging (SALSA). In aim 2, we will evaluate the role of diastolic BP across level of health status. Finally, based on findings from these observational cohorts, in aim 3 we will evaluate whether these factors can identify elderly persons in whom treatment to lower BP is of maximum benefit in two randomized controlled trials: the Systolic Hypertension in the Elderly (SHEP) and the Secondary Prevention of Small Subcortical Strokes (SPS3). Since participants in trials are healthier than the U.S. population, we will also evaluate the effect of treatment in the observational studies, using state-of-the-art causal inference methods, which can correct for the bias of standard analytic approaches. Completion of these aims will substantially advance our understanding of the importance of high BP in older adults; will improve our ability to identify elderly persons who will benefit from BP treatment; will allow a systematic understanding of groups in whom evidence for BP treatment is lacking; and will guide design of future trials of hypertension in elderly adults.
描述(由申请人提供):超过60%的65岁的成年人有高血压(BP),但老年人高血压的最佳管理仍然存在争议。与中年人降低血压明显有益的证据相反,老年人的数据则相反

项目成果

期刊论文数量(0)
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Michelle Christina Odden其他文献

Michelle Christina Odden的其他文献

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{{ truncateString('Michelle Christina Odden', 18)}}的其他基金

Population Health Aging Research - Advancing Health Equity and Diversity (PHAR-AHEaD)
人口健康老龄化研究 - 促进健康公平和多样性 (PHAR-AHEaD)
  • 批准号:
    10629072
  • 财政年份:
    2023
  • 资助金额:
    $ 31.26万
  • 项目类别:
Cardiovascular and Cerebrovascular Risk Factors for Mobility Limitation in the Jackson Heart Study
杰克逊心脏研究中导致活动受限的心脑血管危险因素
  • 批准号:
    10576340
  • 财政年份:
    2020
  • 资助金额:
    $ 31.26万
  • 项目类别:
Cardiovascular and Cerebrovascular Risk Factors for Mobility Limitation in the Jackson Heart Study
杰克逊心脏研究中导致活动受限的心脑血管危险因素
  • 批准号:
    10152490
  • 财政年份:
    2020
  • 资助金额:
    $ 31.26万
  • 项目类别:
Cardiovascular and Cerebrovascular Risk Factors for Mobility Limitation in the Jackson Heart Study
杰克逊心脏研究中导致活动受限的心脑血管危险因素
  • 批准号:
    10359113
  • 财政年份:
    2020
  • 资助金额:
    $ 31.26万
  • 项目类别:
Cardiovascular and Cerebrovascular Risk Factors for Mobility Limitation in the Jackson Heart Study
杰克逊心脏研究中导致活动受限的心脑血管危险因素
  • 批准号:
    9922637
  • 财政年份:
    2020
  • 资助金额:
    $ 31.26万
  • 项目类别:
A New Paradigm for Hypertension in the Elderly- Beyond Age
老年人高血压的新范式——超越年龄
  • 批准号:
    9519485
  • 财政年份:
    2017
  • 资助金额:
    $ 31.26万
  • 项目类别:
A New Paradigm for Hypertension in the Elderly- Beyond Age
老年人高血压的新范式——超越年龄
  • 批准号:
    8756375
  • 财政年份:
    2014
  • 资助金额:
    $ 31.26万
  • 项目类别:
A New Paradigm for Hypertension in the Elderly- Beyond Age
老年人高血压的新范式——超越年龄
  • 批准号:
    9185255
  • 财政年份:
    2014
  • 资助金额:
    $ 31.26万
  • 项目类别:
Modeling Optimal Strategies to Prevent Cardiovascular Events in Older Adults
模拟预防老年人心血管事件的最佳策略
  • 批准号:
    9015740
  • 财政年份:
    2012
  • 资助金额:
    $ 31.26万
  • 项目类别:
Modeling Optimal Strategies to Prevent Cardiovascular Events in Older Adults
模拟预防老年人心血管事件的最佳策略
  • 批准号:
    8416372
  • 财政年份:
    2012
  • 资助金额:
    $ 31.26万
  • 项目类别:

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