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

这项K24提案将使首席研究员Adam Bress博士有时间和支持来(1)继续他的 成功指导早期调查人员的跟踪记录和(2)扩大其指导的老龄化相关 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 预防与衰老有关的多种疾病，包括阿尔茨海默病和相关痴呆(ADRD)和 心血管疾病(CVD)。他的短期职业目标是(1)加强他的指导技能 对不同的受训干部进行对文化敏感的指导，(2)学习SDoH分析的新技能 和认知、脑结构和脆弱的结果，以及(3)扩大抗HTN的基础设施 犹他大学(UU)的药物流行病学培训。指导计划：HIS的核心组成部分 辅导计划是一种个性化的培训方法，它包括需求评估、个人 发展计划、同行指导和编写问责制小组、正在进行的密集评价进程， 和广阔的导师网络。研究策略和与职业目标的协同性和 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 未充分利用或误用的。利用通过K24获得的新知识，Bress博士利用他的成功 POR计划、现有资金和强大的机构资源，以创造独特的培训机会 通过三个明确的、相关的、由学员主导的关于老龄化的POR项目。这些研究利用 现有R01资助的POR使用收缩压(BP)干预试验(Sprint)，行动控制 糖尿病中的心血管风险(ACCORD)研究，以及地理和种族差异的原因 中风(问候)研究。研究目的是(1)确定集约化作业对人群健康的影响 血压(BP)治疗根据SDoH和虚弱状态使用方面，(2)确定 药房沙漠、抗HTN药物使用和血压控制之间的关系，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使用的相关性 短跑和一致时的认知功能和脑白质损毁体积。通过这些研究，辅导者 在(1)在与其职业匹配的领域指导和领导与老龄化相关的POR方面获得实践经验 目标，(2)手稿编写和传播，(3)获得初步数据以支持自己的K/R01 申请。摘要：Bress博士在衰老相关HTN药物流行病学方面对POR的坚定承诺， 个性化的导师计划，学员的直接参与，专家共同导师的可用性，以及 杰出的机构支持是确保其学员具有强大的POR生产力的优势 并获得必要的技能和经验，成为具有以下能力的独立科学家 指导、评估和传播与老龄化相关的高质量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.