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

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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.