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岁以上的成年人，是为数不多的可改变的风险之一 预防老年人痴呆症和心血管疾病(CVD)事件的因素。然而，目前的做法是 高血压筛查和治疗指南主要关注血压测量 在临床环境中获得。这种对实体办公室进行BP测量的依赖代表着一个重要的 老年人的障碍，他们经常依赖他人提供交通工具，并面临更大的严重 当前新冠肺炎大流行导致的发病率。家庭血压监测(HBPM)显示出令人难以置信的前景 更有效、更及时地治疗和控制BP。此外，目前的大流行催化了 广泛采用HBPM进行高血压筛查和管理。然而，这种做法的证据 在老年人中严重缺乏。事实上，在中国的老年人口中，几乎没有HBPM队列研究 美国。这一点尤其令人担忧，因为临床和家庭BP之间的不一致随着 年龄，使老年人特别容易受到过度激进或延迟的BP治疗的伤害。 在这项拟议的研究中，我们应用了我们对HBPM和24小时动态血压的独特专业知识 对美国历史最悠久、最受尊敬的社区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已经在临床上严格测量血压 通过自动化设备设置，我们的提案将额外评估8天的HBPM和24小时的门诊 在2142名80岁以上不同种族的成年人中进行了BP(每20分钟一次)，这可能是最大的 世界各地老年人家庭、门诊和门诊血压测量的前瞻性研究。这 建议旨在通过表征HBPM的测量来直接为临床实践提供信息 绩效(偏差和方差)，对关键长期事件(痴呆症和心血管疾病)的预测性，以及 解释(即，根据ABPM或临床测量的血压，家庭测量的血压等于什么)。 这项提议的完成将解决与日益增长的利用相关的知识的严重差距 血压测量的形式，通过建立有效的方案改善及时高血压护理的机会 在国内精确测量血压。此外，通过投资ARIC研究的数字监测平台， 这一建议将为远程收集广泛的详细的、纵向的生物传感器数据奠定基础 在未来几年，许多调查人员可以通过随后的ARIC提案来利用这一点。 随着目前美国老年人对BP控制的趋势恶化，从来没有 更需要研究创新技术，以改善获得高质量BP测量的机会。 最终，我们的建议直接响应了NHLBI 2017年高血压测量专家小组的呼吁 确定ABPM和HBPM在诊断…中的作用的影响研究《高血压》和《The 使用HBPM…的最佳协议诊断和评估…高血压。“