Home blood pressure and falls among older adults

心血管疾病(CVD)是美国老年人死亡的主要原因。超过75%的美国成年人使用≥ 65岁有高血压，是心血管疾病的主要危险因素。随机对照试验有 证明通过降压药物降低血压可降低患心血管疾病的风险 在患有高血压的老年人中增加20%到40%。许多美国老年人患有失控的BP，可能 从加强抗高血压药物中获得降低心血管疾病风险的好处。然而，临床医生 他们经常担心，大幅降低BP可能会增加跌倒的风险。跌倒是导致 美国老年人和超过三分之一的美国成年人与伤害相关的住院和死亡≥65 年龄每年都会下降。传统上，BP是在临床环境中测量的，主要的 临床医生在决定滴定抗高血压药物时遇到的挑战是BP的不准确性 在这种情况下进行评估。家庭血压监测(HBPM)是一种廉价且高度可行的方法 在临床环境之外测量血压的方法，具有改善血压控制的潜力， 因此，降低心血管疾病的风险。HBPM能否确定哪些患者可以服用降压药 在没有增加跌倒风险的情况下加强的情况尚不清楚。美国国立卫生研究院新资助(2018年7月1日至2022年6月30日) 前瞻性队列研究(老年人的动态血压[安布罗西亚])将评估 使用动态血压监测(ABPM)在临床环境之外测量的BP相关性， 在1,057名65岁的≥成年人中，服用凯撒公司的降压药有跌倒风险 永久南加州(KPSC)医疗系统。ABPM被选为安布罗西亚研究的原样 被认为是评估门诊BP的黄金标准方法。与ABPM相比，HBPM更多 在美国广泛使用，患者耐受性更好。安布罗西亚的研究不是为了执行 HBPM。拟议的对安布罗西亚的辅助研究的总体目标是确定BP是否对HBPM 可以确定服用降压药的老年人跌倒的风险增加，以及 与ABPM相比，HBPM对跌倒提供了类似的预测价值。安布罗西亚将开始考察访问 2019年2月，拟议的辅助研究(安布罗西亚-HOME)将增加#年HBPM的实施 天，早上测量两个BP，晚上测量两个BP 每天，在对1,000名参与者进行ABPM之后。进行安布罗西亚-家庭研究 将具有成本效益，因为人口统计和临床特征、老年评估、 研究级BP测量，24小时ABPM已经在基线上收集，包括瀑布和 在一年的随访期内对严重坠落伤进行评估。安布罗西亚家庭研究将 提供有关HBPM在为服用抗高血压药物的老年人提供个性化护理方面的作用的有价值的数据 药物治疗。

Cardiovascular disease (CVD) is the leading cause of death among older US adults. Over 75% of US adults ≥ 65 years of age have hypertension, a major risk factor for CVD. Randomized controlled trials have demonstrated that lowering blood pressure (BP) through antihypertensive medication reduces the risk for CVD by 20% to 40% among older adults with hypertension. Many older US adults have uncontrolled BP and may receive CVD risk reduction benefits from intensifying their antihypertensive medication. However, clinicians are often concerned that intensively lowering BP may increase the risk for a fall. Falls are the leading cause of injury-related hospitalization and death among older US adults and more than one in three US adults ≥ 65 years of age experience a fall each year. BP has traditionally been measured in the clinic setting and a major challenge that clinicians encounter in deciding to titrate antihypertensive medication is the inaccuracy of BP assessed in this setting. Home blood pressure monitoring (HBPM) is an inexpensive and highly feasible approach to measure BP outside of the clinic setting and has the potential to improve BP control and, therefore, reduce CVD risk. Whether HBPM can identify patients for whom antihypertensive medication can be intensified without increasing the risk for a fall is unknown. A newly NIH-funded (July 1, 2018 to June 30, 2022) prospective cohort study (AMBulatoRy blOod preSsure In older Adults [AMBROSIA]) will evaluate the association of BP, measured outside of the clinic setting using ambulatory blood pressure monitoring (ABPM), with falls risk among 1,057 adults aged ≥ 65 years, taking antihypertensive medication from the Kaiser Permanente Southern California (KPSC) health system. ABPM was chosen for the AMBROSIA study as it is considered the gold-standard approach for assessing out-of-clinic BP. Compared to ABPM, HBPM is more widely available in the US and better tolerated by patients. The AMBROSIA study is not funded to perform HBPM. The overall goal of the proposed ancillary study to AMBROSIA is to determine whether BP on HBPM can identify older adults taking antihypertensive medication who are at increased risk for falls, and whether HBPM provides similar predictive value for falls when compared with ABPM. AMBROSIA will begin study visits in February 2019 and the proposed ancillary study (AMBROSIA-HOME) will add the conduct of HBPM for 7 days, with two BP measurements obtained in the morning and two BP measurements obtained in the evening on each day, following the conduct of ABPM for 1,000 participants. Conducting the AMBROSIA-HOME study will be cost-efficient as information on demographic and clinical characteristics, geriatric assessments, research-grade BP measurements, and 24-hour ABPM is already being collected at baseline with falls and serious fall injuries being assessed during a one-year follow-up period. The AMBROSIA-HOME study will provide valuable data on the role of HBPM to personalize care for older adults taking antihypertensive medication.