Blood Pressure Measurement and Hypertension in Pregnancy

妊娠期血压测量和高血压

• 批准号: 10397064
• 负责人: Natalie A Bello
• 金额: $ 17.42万
• 依托单位: CEDARS-SINAI MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-27 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10397064
• 关键词: Abruptio Placentae; Address; Adherence; Adult; Affect; Ambulatory Blood Pressure Monitoring; Antihypertensive Agents; Biometry; Blood Pressure; Blood pressure determination; Chronic; Clinic; Clinical; Complex; Data; Devices; Diagnosis; Diastolic blood pressure; Disease; Environment; Epidemiology; Fetal Growth Retardation; Fetus; Foundations; Future; Goals; Guidelines; Health Personnel; Home; Home Blood Pressure Monitoring; Hour; Hypertension; Individual; K-Series Research Career Programs; Knowledge; Maternal-fetal medicine; Measurement; Measures; Medical; Monitor; Morbidity - disease rate; Mothers; Outcome; Patients; Perfusion; Pharmaceutical Preparations; Placental Insufficiency; Population; Pregnancy; Pregnant Women; Premature Birth; Prevalence; Public Health; Reading; Reporting; Research; Research Design; Research Personnel; Risk; Role; Second Pregnancy Trimester; Statistical Data Interpretation; Stroke; Training; Validation; Woman; base; blood pressure elevation; career; career development; design; evidence base; fetal; hemodynamics; high risk; hypertension treatment; men; monitoring device; mortality; multidisciplinary; overtreatment; pregnancy disorder; pregnancy hypertension; pregnant; pressure; programs; research data dissemination

PROJECT SUMMARY/ABSTRACT Dr. Natalie A. Bello is a cardiologist whose long-term career goal is to generate and disseminate empiric evidence to reduce the burden of maternal-fetal morbidity and mortality resulting from hypertensive disorders of pregnancy (HDP). She seeks a K23 Career Development Award to attain this goal, and has assembled a multidisciplinary team of senior investigators in hypertension (HTN) (Drs. Daichi Shimbo and Suzanne Oparil), out-of-clinic blood pressure (BP) measurement including home BP monitoring (HBPM) (Drs. Shimbo and Joseph Schwartz), epidemiology (Dr. Paul Muntner), maternal-fetal medicine (Drs. Alan Tita and Ronald Wapner), and biostatistics (Drs. Schwartz and Muntner). Dr. Bello’s training will consist of four modules: (1) Hypertensive Disorders of Pregnancy, (2) Research Aspects of the Diagnosis and Treatment of HTN, (3) Advanced Study Design and Statistical Analysis in HTN, and (4) Research Dissemination and Transition to Independence. HDP, including chronic and gestational HTN, are associated with substantial maternal-fetal morbidity and mortality. The accurate determination of BP in pregnant women with chronic and gestational HTN is essential, as both under- and over-treatment of HTN may result in harm to the mother and/or fetus. Traditional clinic BP (CBP), which involves a healthcare provider measuring BP, is a poor surrogate for ecological BP in the naturalistic environment. Compared to CBP, out-of-clinic BP on HBPM better estimates ecological BP, and thus may be a superior measure of placental perfusion. Although these data suggest that HBPM has an essential role in the management of chronic and gestational HTN, there are several knowledge gaps that limit the widespread use of HBPM in this population. The minimum number of days of HBPM to reliably estimate mean home BP, and the long-term adherence to HBPM during pregnancy among women with chronic and gestational HTN are unknown. Finally, studies of non-pregnant individuals show that compared to traditional CBP, CBP measured using an automated device in the absence of a healthcare provider (unattended CBP) may better approximate out-of-clinic BP. In the proposed project, the minimum number of days of HBPM needed to provide a reliable estimate of mean home BP (Primary Aim 1) and the long-term adherence to HBPM during pregnancy (Primary Aim 2) will be determined. Whether mean unattended CBP versus traditional CBP is closer to mean home BP (Secondary Aim) will also be assessed. Primary Aim 1 and Secondary Aim will be addressed among 105 pregnant women (<34 weeks gestation) with chronic and gestational HTN who will undergo HBPM for 14 days with traditional and unattended CBP measurement (Study 1). Primary Aim 2 will be addressed among 75 pregnant women with chronic and gestational HTN who will undergo HBPM daily from the second trimester (gestational week 20-26) through delivery (Study 2). These data will inform Dr. Bello’s program of research on HDP, and will provide the foundation for her to design larger outcomes-based studies (R01) examining the role of HBPM and CBP in pregnancy. 1

项目摘要/摘要 娜塔莉·A·贝洛博士是一位心脏病专家，她的长期职业目标是创造和传播经验主义 减少高血压引起的母婴发病率和死亡率负担的证据 妊娠(HDP)。为了实现这一目标，她寻求获得K23职业发展奖，并组建了一个 高血压(HTN)多学科高级研究小组(Daichi Shimbo博士和Suzanne Oparil博士)， 门诊血压(BP)测量，包括家庭血压监测(HBPM)(Shimbo和 约瑟夫·施瓦茨)，流行病学(保罗·蒙特纳博士)，母胎医学(艾伦·蒂塔和罗纳德博士 和生物统计学(Schwartz和Muntner博士)。贝洛博士的培训将包括四个模块：(1) 妊娠高血压疾病，(2)HTN的诊断和治疗研究，(3) HTN的高级研究设计和统计分析，以及(4)研究传播和过渡到 独立。HDP，包括慢性和妊娠期HTN，与母婴关系密切 发病率和死亡率。慢性妊娠妇女血压的准确测定 HTN是必不可少的，因为HTN的治疗不足和过度都可能导致对母亲和/或胎儿的伤害。 传统的临床BP(CBP)涉及到医疗保健提供者测量BP，不是一个很好的替代品 自然主义环境中的生态BP。与CBP相比，门诊BP对HBPM的估计更好 生态血压，因此可能是胎盘血流灌注的一个更好的量度。尽管这些数据表明 HBPM在慢性和妊娠期HTN的管理中起着至关重要的作用，有几点认识 限制HBPM在这一人群中广泛使用的差距。HBPM的最短天数为 可靠地估计平均家庭血压，以及怀孕期间长期坚持HBPM的妇女 慢性和妊娠期HTN尚不清楚。最后，对未怀孕个体的研究表明，与 传统的CBP，在没有医疗保健提供者的情况下使用自动化设备测量CBP (无人值守的CBP)可能更接近门诊BP。在拟议的项目中，最低数量 HBPM的天数需要提供平均家庭血压的可靠估计(主要目标1)和长期 将确定怀孕期间坚持HBPM(主要目标2)。是否意味着无人看管CBP 与传统的CBP相比，更接近平均主场BP(二级目标)也将得到评估。主要目标1和 第二个目标将在105名患有慢性和非传染性疾病的孕妇(妊娠34周)中解决。 妊娠期HTN患者将接受为期14天的HBPM，并进行传统和无人值守的CBP测量(研究 1)。主要目标2将在75名患有慢性妊娠期HTN的孕妇中解决，这些孕妇将 从妊娠中期(妊娠20-26周)到分娩，每天进行HBPM(研究2)。这些 数据将为贝洛博士的HDP研究计划提供信息，并将为她设计更大的 以结果为基础的研究(R01)检查HBPM和CBP在怀孕中的作用。 1

项目成果

Cardiac Abnormalities in Hispanic/Latina Women With Prior De Novo Hypertensive Disorders of Pregnancy.

• DOI: 10.1161/hypertensionaha.123.21248
• 发表时间: 2024-02
• 期刊: HYPERTENSION
• 影响因子: 8.3
• 作者: Quesada, Odayme;Kulandavelu, Shathiyah;Vladutiu, Catherine J.;DeFranco, Emily;Minissian, Margo B.;Makarem, Nour;Bello, Natalie A.;Wong, Melissa S.;Pabon, Maria A.;Chandra, Alvin A.;Aviles-Santa, Larissa;Rodriguez, Carlos J.;Bairey Merz, C. Noel;Sofer, Tamar;Hurwitz, Barry E.;Talavera, Gregory A.;Claggett, Brian L.;Solomon, Scott D.;Cheng, Susan
• 通讯作者: Cheng, Susan

Adverse Pregnancy Outcomes-Risk Enhancers Whose Time Has Finally Arrived.

不良妊娠结果——风险增强剂的时代终于到来了。

• DOI: 10.1001/jama.2022.24387
• 发表时间: 2023
• 期刊: JAMA
• 作者: Bello,NatalieA

Cases in Precision Medicine: A Personalized Approach to Stroke and Cardiovascular Risk Assessment in Women.

精准医学案例：女性中风和心血管风险评估的个性化方法。

• DOI: 10.7326/m19-1601
• 发表时间: 2019
• 期刊: Annals of internal medicine
• 影响因子: 39.2
• 作者: Bello,NatalieA;Miller,ElizaC;Cleary,KirstenLawrence;Wapner,Ronald
• 通讯作者: Wapner,Ronald

Similarity-based health risk prediction using Domain Fusion and electronic health records data.

• DOI: 10.1016/j.jbi.2021.103711
• 发表时间: 2021-04
• 期刊: Journal of biomedical informatics
• 影响因子: 4.5
• 作者: Guo J;Yuan C;Shang N;Zheng T;Bello NA;Kiryluk K;Weng C;Wang S
• 通讯作者: Wang S

Associations Between Sleep Disorders and Hypertensive Disorders of Pregnancy and Materno-fetal Consequences.

• DOI: 10.1007/s11906-020-01066-w
• 发表时间: 2020-07-15
• 期刊: Current hypertension reports
• 影响因子: 5.6
• 作者: Querejeta Roca G;Anyaso J;Redline S;Bello NA
• 通讯作者: Bello NA