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

高血压影响超过85%的75岁以上的成年人，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主要关注血压（BP）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， 老年人的障碍，他们经常依赖他人运输，并且严重的风险增加 新冠肺炎疫情的发病率。家庭BP监测（HBPM）显示出令人难以置信的前景， 更有效和及时的BP治疗和控制。此外，目前的流行病已经催化了 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，几乎没有HBPM队列研究在老年人群中， 美国的这一点尤其令人担忧，因为诊所和家庭BP之间的不一致性随着时间的推移而增加。 年龄，使老年人特别容易受到过度积极或延迟BP治疗的伤害。 在这项拟议的研究中，我们运用我们独特的专业知识与HBPM和24小时动态血压 监测到一个最长期和最受尊敬的美国社区居住的成年人群体， 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BP， 通过自动化设备设置，我们的建议将额外评估8天的HBPM和24小时的门诊 BP（每20分钟一次）在2,142名80岁以上的不同种族成年人中， 一项对全球老年人进行的家庭、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的测量结果，直接告知临床实践 性能（偏差和方差），对关键长期事件（痴呆和CVD）的预测性，以及 解释（即家庭BP测量值等于ABPM或诊所测量的BP）。 这一提议的完成将填补与日益利用的 血压测量的形式，通过建立一个有效的协议， 在家精确测量血压。此外，通过投资ARIC研究的数字监测平台， 这项建议将为远程收集大量详细的纵向生物传感器数据奠定基础 在未来几年，许多研究人员可以通过随后的ARIC提案来利用这一点。 随着美国老年人血压控制恶化的趋势， 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，我们的提案直接回应了NHLBI 2017年BP测量专家小组的呼吁， 影响研究，确定“ABPM和HBPM在高血压诊断中的作用”和“ 使用HBPM诊断和评估高血压的最佳方案。”

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.”