Prognostic Implications of Home-Based Blood Pressure Monitoring in Older Adults

老年人家庭血压监测的预后意义

• 批准号: 10631185
• 负责人: STEPHEN P JURASCHEK
• 金额: $ 72.76万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-20 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10631185
• 关键词: Address; Adoption; Adult; Affect; Age; Age Years; Aged, 80 and over; Ambulatory Blood Pressure Monitoring; American; Atherosclerosis Risk in Communities; Biosensor; Blood Pressure; Blood Pressure Monitors; COVID-19; COVID-19 pandemic; Cardiovascular Diseases; Caring; Cessation of life; Clinic; Clinic Visits; Clinical; Cohort Studies; Collection; Communities; Coronavirus Infections; Data; Dementia; Devices; Diagnosis; Elderly; Event; Foundations; Frequencies; Funding; Goals; Health; Home; Home Blood Pressure Monitoring; Hour; Hypertension; Impaired cognition; Improve Access; Intervention Trial; Investments; Joints; Knowledge; Machine Learning; Measurement; Measures; Modeling; Morbidity - disease rate; National Heart, Lung, and Blood Institute; Neurocognitive; Outcome; Participant; Performance; Population; Population Heterogeneity; Practice Guidelines; Predisposition; Prospective Studies; Protocols documentation; Research; Research Personnel; Risk; Risk Factors; Role; Translations; Transportation; United States; Visit; Vulnerable Populations; aged; aggressive therapy; aging population; blood pressure control; blood pressure elevation; blood pressure intervention; blood pressure variability; clinical practice; cohort; current pandemic; dementia risk; design; digital monitoring; human old age (65+); improved; innovative technologies; modifiable risk; outcome prediction; prevent; prognostic; prognostic performance; prognostic value; racial diversity; risk prediction; risk prediction model; screening; tool; transportation access; trend; virtual

Hypertension affects over 85% of adults over 75 years of age and represents one of the few modifiable risk factors to prevent dementia and cardiovascular disease (CVD) events in older adults. However, current practice guidelines for hypertension screening and treatment focus heavily on blood pressure (BP) measurements obtained in clinic settings. This reliance on brick-and-mortar offices for BP measurement represents a significant barrier for older adults, who often depend on others for transportation and who are at increased risk of severe morbidity from the current COVID-19 pandemic. Home BP monitoring (HBPM) has shown incredible promise for more effective and timely BP treatment and control. Furthermore, the current pandemic has catalyzed widespread adoption of HBPM for hypertension screening and management. However, evidence for this practice is severely lacking in older adults. In fact, there are virtually no HBPM cohort studies in elderly populations in the United States. This is particularly concerning as the discordance between clinic and home BP increases with age, making older adults especially susceptible to harms from either overly aggressive or delayed BP treatment. In this proposed study, we apply our unique expertise with HBPM and 24-hour ambulatory blood pressure monitoring to one of the most long-standing and well-respected American cohorts of community-dwelling adults, the Atherosclerosis Risk in Communities Study (ARIC). While ARIC already rigorously measures BP in the clinic setting via automated devices, our proposal will additionally assess 8 days of HBPM and 24 hours of ambulatory BP (once every 20 minutes) in 2,142 racially diverse adults over age 80 years, establishing possibly the largest prospective study of home, ambulatory, and clinic-based BP measurement among older adults in the world. This proposal is designed to directly inform clinical practice with HBPM by characterizing its measurement performance (bias and variance), predictiveness with respect to key long-term events (dementia and CVD), and interpretation (i.e. what a home BP measure equals in terms of BP measured by ABPM or in clinic). The accomplishment of this proposal will address critical gaps in knowledge related to an increasingly utilized form of BP measurement, improving access to timely hypertension care by establishing an efficient protocol for precise BP measurement at home. Moreover, by investing in the digital monitoring platform of the ARIC study, this proposal will lay the foundation for remote collection of a wide range of detailed, longitudinal, biosensor data that can be leveraged by many investigators through subsequent ARIC proposals in years to come. With current trends in BP control worsening among older adults in the United States, there has never been a greater need for research on innovative technologies to improve access to high quality BP measurement. Ultimately, our proposal directly answers the call by NHLBI's 2017 expert panel on BP measurement for high impact research that determines “the role of ABPM and HBPM in the diagnosis…of hypertension” and “the optimal protocol for using HBPM…to diagnose and assess…hypertension.”

高血压影响超过 85% 的 75 岁以上成年人，是少数可改变的风险之一 预防老年人痴呆和心血管疾病（CVD）事件的因素。然而，目前的做法 高血压筛查和治疗指南重点关注血压 (BP) 测量 在诊所环境中获得。这种对实体办公室进行血压测量的依赖代表了显着的 老年人的障碍，他们经常依赖他人进行交通，并且患严重疾病的风险增加 当前 COVID-19 大流行的发病率。家庭血压监测 (HBPM) 已显示出令人难以置信的前景 更有效、及时的血压治疗和控制。此外，当前的疫情也加剧了 广泛采用 HBPM 进行高血压筛查和管理。然而，这种做法的证据 老年人严重缺乏。事实上，美国几乎没有针对老年人群的 HBPM 队列研究。 美国。这尤其令人担忧，因为诊所和家庭血压之间的不一致随着时间的推移而增加 年龄，使得老年人特别容易受到过度积极或延迟血压治疗的伤害。 在这项拟议的研究中，我们运用了 HBPM 和 24 小时动态血压方面的独特专业知识 对美国最古老、最受尊敬的社区居住成年人群体之一进行监测， 社区动脉粥样硬化风险研究 (ARIC)。虽然 ARIC 已经在诊所严格测量血压 通过自动化设备设置，我们的建议将另外评估 8 天的 HBPM 和 24 小时的动态 对 2,142 名年龄超过 80 岁的不同种族成年人进行 BP（每 20 分钟一次），建立了可能是最大的 对世界老年人进行家庭、门诊和诊所血压测量的前瞻性研究。这 该提案旨在通过表征 HBPM 的测量来直接为临床实践提供信息 绩效（偏差和方差）、关键长期事件（痴呆和心血管疾病）的预测性，以及 解释（即家庭血压测量值等于 ABPM 或诊所测量的血压值）。 该提案的完成将解决与日益使用的相关知识中的关键差距 血压测量的形式，通过建立有效的协议来改善及时获得高血压护理的机会 在家进行精确血压测量。此外，通过投资ARIC研究的数字监测平台， 该提案将为远程收集广泛的详细纵向生物传感器数据奠定基础 许多研究人员可以在未来几年通过 ARIC 的后续提案来利用这一点。 目前美国老年人的血压控制情况呈恶化趋势，但从未出现过这种情况。 更需要研究创新技术，以改善获得高质量血压测量的机会。 最终，我们的提案直接响应了 NHLBI 2017 年高血压测量专家小组的号召。 影响研究确定了“ABPM 和 HBPM 在高血压诊断中的作用”和“ 使用 HBPM 的最佳方案……诊断和评估……高血压。”