Using pharmacoepidemiology to optimize antihypertensive medication use to prevent aging-related multimorbidity: Midcareer investigator award in patient-oriented research and mentoring.

这项K24提案将使主要研究者Adam Bress博士有时间和支持（1）继续他的研究。 早期研究人员成功指导的跟踪记录，以及（2）扩大他的指导与年龄相关的 和面向患者的研究（POR）计划，以新的重点领域，包括健康的社会决定因素 （SDoH），因为它们与抗高血压（抗HTN）药物的使用、使用不足和不安全使用有关， 预防与衰老相关的多种疾病，包括阿尔茨海默病和相关痴呆症（ADRD）， 心血管疾病（CVD）。他的短期职业目标是（1）加强他的指导技能， 对不同的受训人员进行文化敏感的指导，（2）学习分析SDOH的新技能 和认知，大脑结构和脆弱的结果，（3）扩大抗HTN的基础设施 犹他州大学（UU）的药物流行病学培训。指导计划：他的核心组成部分 辅导计划是一种个性化的培训方法，包括需求评估，个人 发展计划、同侪指导和编写问责制小组、持续的密集评价进程， 和广阔的导师网络。研究战略与职业目标的协同作用， 指导计划：安全有效的抗HTN药物可预防发病率和死亡率，但通常 未充分利用或滥用。利用通过K24获得的新知识，Bress博士利用他成功的 POR计划，当前的资金和强大的机构资源，以创造独特的培训机会 通过三个明确定义的，相关的，和学员领导的关于老龄化的POR项目。这些研究利用了 使用收缩压（BP）干预试验（SPRINT）的现有R 01资助的POR，控制措施 糖尿病心血管风险（雅阁）研究，以及地理和种族差异的原因 卒中（REGARDS）研究。本研究的目的是：（1）确定密集的人群健康影响 根据SDoH和虚弱状态使用REGARDS进行血压（BP）治疗，（2）确定 REGARDS中药房沙漠、抗HTN药物使用和BP控制之间的关联，以及（3） 确定血管紧张素II受体阻滞剂与血管紧张素转换酶抑制剂的相关性， SPRINT和雅阁的认知功能和白色病变体积。通过这些研究，学员 获得以下方面的实践经验：（1）在与其职业生涯相匹配的领域开展和领导与老龄化相关的POR 目标，（2）手稿撰写和传播，以及（3）获得初步数据以支持自己的K/R 01 应用.总结：Bress博士在与衰老相关的HTN药物流行病学方面对POR的坚定承诺， 个性化的指导计划，学员的直接参与，专家共同导师的可用性，以及 出色的机构支持是确保他的学员具有强大的POR生产力的优势 并获得成为独立科学家所需的技能和经验， 开展、评估和传播高质量的老龄化相关POR。

This K24 proposal will allow the principal investigator, Dr. Adam Bress, time and support to (1) continue his track record of successful mentorship of early-stage investigators and (2) expand his mentored aging-related and patient-oriented research (POR) program to new focus areas, including social determinants of health (SDoH) as they relate to the use, underuse, and unsafe use of antihypertensive (anti-HTN) medications to prevent aging-related multimorbidity including Alzheimer’s disease and related dementias (ADRD) and cardiovascular disease (CVD). His short-term career goals are to (1) strengthen his mentoring skills in culturally-sensitive mentoring across a diverse cadre of trainees, (2) learn new skills in the analysis of SDoH and cognitive, brain structure, and frailty outcomes, and (3) expand infrastructure for anti-HTN pharmacoepidemiology training at the University of Utah (UU). Mentoring Plan: A central component of his mentoring program is an individualized approach to training, which includes a needs assessment, individual development plan, peer-mentoring and writing accountability groups, ongoing intensive evaluation process, and expansive mentorship network. Research Strategy and Synergy with Career Objectives and Mentoring Plan: Safe and effective anti-HTN medications prevent morbidity and mortality but are often underused or misused. Using new knowledge gained through the K24, Dr. Bress leverages his successful POR program, current funding, and robust institutional resources to create unique training opportunities through three well-defined, related, and mentee-led POR projects on aging. These studies leverage existing R01-funded POR using the Systolic Blood Pressure (BP) Intervention Trial (SPRINT), Action to Control Cardiovascular Risk in Diabetes (ACCORD) study, and REasons for Geographic And Racial Differences in Stroke (REGARDS) study. The research aims are to (1) determine the population health impact of intensive blood pressure (BP) treatment according to SDoH and frailty status using REGARDS, (2) determine associations among pharmacy deserts, anti-HTN medication use, and BP control in REGARDS, and (3) determine the association of angiotensin II receptor blocker vs. angiotensin-converting enzyme inhibitor use on cognitive function and white matter lesion volume in SPRINT and ACCORD. Through these studies, mentees gain practical experience in (1) conducting and leading aging-related POR in an area that matches their career goals, (2) manuscript writing and dissemination, and (3) obtaining preliminary data to support their own K/R01 applications. Summary: Dr. Bress's strong commitment to POR in aging-related HTN pharmacoepidemiology, an individualized mentorship plan, direct involvement of the mentees, availability of expert co-mentors, and outstanding institutional support are strengths that will ensure that his mentees have strong POR productivity and gain the skills and experience necessary to become independent scientists with competencies in conducting, evaluating, and disseminating high-quality aging-related POR.