Home Blood Pressure Outcomes Evaluation Study (HOMESTEAD)
家庭血压结果评估研究 (HOMESTEAD)
基本信息
- 批准号:10619516
- 负责人:
- 金额:$ 47.19万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2022
- 资助国家:美国
- 起止时间:2022-06-01 至 2026-05-31
- 项目状态:未结题
- 来源:
- 关键词:Acute Renal Failure with Renal Papillary NecrosisAddressAdherenceAdultAdverse eventAgeAmericanAmerican Heart AssociationAntihypertensive AgentsBlood PressureCardiologyCardiovascular systemCaringCase ManagementCase ManagerCessation of lifeCharacteristicsChronic DiseaseClinicClinicalClinical TrialsCountryDataDiagnosisDisease ManagementEffectivenessElectrolytesEnrollmentEthnic OriginEvaluation StudiesEventGoalsGuidelinesHomeHome Blood Pressure MonitoringHypertensionIndividualKnowledgeLinkMeasurementMeasuresMethodsMorbidity - disease rateNephrologyObservational StudyOutcomePatient SelectionPatientsPersonsPharmaceutical PreparationsPopulation HeterogeneityProviderRaceRandomized, Controlled TrialsRecommendationReportingRiskRisk FactorsRisk ReductionSiteSocioeconomic StatusSubgroupTimeUnited States Preventative Services Task ForceVariantVeteransadverse event riskadverse outcomeblood pressure medicationblood pressure reductionclinical practiceclinical riskcohortcollegecomorbiditydesigneffectiveness evaluationhealth datahypertension controlimplementation strategyimprovedmedication compliancemortalityparticipant enrollmentprogramsroutine practicesextelehealthtransmission process
项目摘要
PROJECT ABSTRACT
Over 100 million US adults have hypertension, the number one chronic disease risk factor in the world. The
United States Preventive Services Task Force and the 2017 American College of Cardiology/American Heart
Association blood pressure (BP) guidelines recommends measuring BP outside of the clinic for the diagnosis
and management of hypertension. Home blood pressure monitoring (HBPM) involves self-measurement of BP
by the patient and is the most common method for assessing out-of-office BP in the US. The guideline
recommendations are based on high-quality observational studies in which out-of-office BP was typically
obtained at a single point and individuals with high out-of-office BP were observed to have higher rates of
cardiovascular outcomes and increased rates of all-cause mortality, regardless of office BP levels. Additionally,
clinical trials have demonstrated that HBPM reduces clinic BP over short 6-12 month time frames, especially
when combined with disease management programs. There are no studies evaluating the effectiveness of
HBPM in routine clinical practice in a diverse population from across the country. Additionally, there are a lack
of data on: a) whether use of HBPM reduces risk for clinical outcomes; b) the impact of HBPM on both short-
and long-term clinic BP, clinical inertia, and medication adherence in routine clinical practice; and c) how
clinicians and patients utilize HBPM. Over the last ~10 years, approximately 400,000 Veterans have measured
home BPs as part of the VA’s telehealth program. We propose to identify Veterans age 18-90 years with
uncontrolled clinic BP enrolled in HBPM programs and a cohort of Veterans not enrolled in HBPM programs.
We will link telehealth data to clinical and outcome data. The proposal will make use of the large number of
patients enrolled in the VA’s HBPM program and the variation in how the HBPM program is implemented
across VA sites. In Aim 1, we will evaluate the effect of HBPM on major adverse cardiovascular events, non-
cancer mortality, and adverse events. In Aim 2, we will assess the impact of HBPM on clinic BP, BP
medication intensification, and medication adherence. In Aim 3, we will determine facility-, provider-, and
patient-level factors associated with use of HBPM in routine practice. Results will establish a) the long-term
benefits of HBPM, b) the association between HBPM and clinical events, and c) the effects in important
subgroups. These findings will inform selection of patients for and the design of a much-needed randomized
controlled trial evaluating the effect of HBPM on clinical outcomes compared to office-based hypertension
management. Additionally, identifying factors associated with greater reductions in BP and greater number of
home BP values transmitted, such as case management programs, may identify barriers to adherence that can
be addressed and inform implementation strategies and the use of HBPM in clinical practice. The proposed
study will answer questions critically important to implementation of HBPM in routine clinical practice with the
ultimate goal of reducing the morbidity and mortality associated with hypertension.
项目摘要
超过1亿美国成年人患有高血压,这是世界上头号慢性病风险因素。这个
美国预防服务工作组和2017美国心脏病学院/美国心脏
协会血压(BP)指南建议在诊所外测量血压以诊断
和高血压的管理。家庭血压监测(HBPM)包括自我测量血压
这是美国评估外出BP最常用的方法。指导方针
建议是基于高质量的观察性研究,在这些研究中,不在办公室的BP通常
在单点获得,并观察到外出高血压的人有更高的发病率
心血管结果和全因死亡率的增加,与办公室血压水平无关。另外,
临床试验表明,HBPM在短短6-12个月的时间内降低临床血压,尤其是
当与疾病管理计划相结合时。目前还没有研究评估这种药物的有效性。
HBPM在全国各地不同人群的常规临床实践中。此外,还有一个缺乏
关于以下方面的数据:a)HBPM的使用是否降低了对临床结果的风险;b)HBPM对短期和长期的
和长期临床血压、临床惰性和常规临床实践中的用药依从性;以及c)如何
临床医生和患者使用HBPM。在过去的10年里,大约有40万退伍军人测量到
家庭BPS是退伍军人管理局远程医疗计划的一部分。我们建议将18-90岁的退伍军人认定为
不受控制的诊所BP参加了HBPM计划,以及一群没有参加HBPM计划的退伍军人。
我们将把远程医疗数据与临床和结果数据联系起来。该提案将利用大量的
参加退伍军人管理局HBPM计划的患者以及HBPM计划实施方式的变化
在退伍军人事务部的各个地点。在目标1中,我们将评估HBPM对主要不良心血管事件的影响,非
癌症死亡率和不良事件。在目标2中,我们将评估HBPM对临床血压的影响
用药强度和用药依从性。在目标3中,我们将确定设施、提供商和
与常规实践中使用HBPM相关的患者水平因素。结果将建立a)长期
HBPM的好处,b)HBPM与临床事件之间的联系,以及c)在
子组。这些发现将为患者的选择和急需的随机设计提供信息
评价HBPM与办公室高血压对临床结果影响的对照试验
管理层。此外,确定与BP更大幅度降低和更多数量的
传输的家庭BP值,例如病例管理程序,可以识别遵守的障碍,这可以
解决并告知实施战略以及HBPM在临床实践中的使用。建议数
研究将回答对在常规临床实践中实施HBPM至关重要的问题
最终目标是降低与高血压相关的发病率和死亡率。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Paul Englund Drawz其他文献
Paul Englund Drawz的其他文献
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{{ truncateString('Paul Englund Drawz', 18)}}的其他基金
Home Blood Pressure Outcomes Evaluation Study (HOMESTEAD)
家庭血压结果评估研究 (HOMESTEAD)
- 批准号:
10364199 - 财政年份:2022
- 资助金额:
$ 47.19万 - 项目类别:
Blood Pressure and Kidney Function - SPRINT vs Electronic Health Record Data
血压和肾功能 - SPRINT 与电子健康记录数据
- 批准号:
10229386 - 财政年份:2017
- 资助金额:
$ 47.19万 - 项目类别:
Blood Pressure and Kidney Function - SPRINT vs Electronic Health Record Data
血压和肾功能 - SPRINT 与电子健康记录数据
- 批准号:
9398771 - 财政年份:2017
- 资助金额:
$ 47.19万 - 项目类别:
Effect of Standard vs Intense Hypertension Management on Nighttime Blood Pressure
标准与强化高血压管理对夜间血压的影响
- 批准号:
8768575 - 财政年份:2014
- 资助金额:
$ 47.19万 - 项目类别:
Effect of Standard vs Intense Hypertension Management on Nighttime Blood Pressure
标准与强化高血压管理对夜间血压的影响
- 批准号:
8898067 - 财政年份:2014
- 资助金额:
$ 47.19万 - 项目类别:
Epidemiology and pathophysiology of elevated nighttime blood pressure in CKD
CKD 夜间血压升高的流行病学和病理生理学
- 批准号:
8065537 - 财政年份:2010
- 资助金额:
$ 47.19万 - 项目类别:
Epidemiology and pathophysiology of elevated nighttime blood pressure in CKD
CKD 夜间血压升高的流行病学和病理生理学
- 批准号:
8514589 - 财政年份:2010
- 资助金额:
$ 47.19万 - 项目类别:
Epidemiology and pathophysiology of elevated nighttime blood pressure in CKD
CKD 夜间血压升高的流行病学和病理生理学
- 批准号:
8299093 - 财政年份:2010
- 资助金额:
$ 47.19万 - 项目类别:
Epidemiology and pathophysiology of elevated nighttime blood pressure in CKD
CKD 夜间血压升高的流行病学和病理生理学
- 批准号:
7875585 - 财政年份:2010
- 资助金额:
$ 47.19万 - 项目类别:
Epidemiology and pathophysiology of elevated nighttime blood pressure in CKD
CKD 夜间血压升高的流行病学和病理生理学
- 批准号:
8686829 - 财政年份:2010
- 资助金额:
$ 47.19万 - 项目类别:
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