Ambulatory Blood Pressure and Cognitive Function in the Systolic Blood Pressure Intervention Trial

收缩压干预试验中的动态血压和认知功能

• 批准号: 9015767
• 负责人: Dena Evette Rifkin
• 金额: $ 8.93万
• 依托单位: VETERANS MEDICAL RESEARCH FDN/SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-03-01 至 2018-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9015767
• 关键词: Adult; Affect; Age; Ambulatory Blood Pressure Monitoring; Ancillary Study; Antihypertensive Agents; Area; Award; Biological Preservation; Blood Pressure; Cardiovascular Diseases; Cardiovascular system; Caregivers; Caring; Cerebrovascular Disorders; Clinic; Clinical Trials; Cognition; Committee Members; Control Groups; Data; Diastolic blood pressure; Elderly; Event; Funding; Goals; Grant; Health; Hour; Hypertension; Hypotension; Impaired cognition; Individual; Intervention Trial; Investigation; Life Expectancy; Literature; Measurement; Measures; Medical; Multicenter Trials; National Institute of Diabetes and Digestive and Kidney Diseases; One-Step dentin bonding system; Outcome; Parents; Participant; Patients; Pattern; Persons; Protocols documentation; Public Health; Quality Control; Randomized; Reading; Recommendation; Recruitment Activity; Reporting; Research Infrastructure; Research Personnel; Site; Testing; Time; Translating; Ursidae Family; Variant; Work; arm; base; blood pressure regulation; cognitive function; cohort; cost; experience; hypertension control; hypertension prevention; improved; primary outcome; randomized trial

 DESCRIPTION (provided by applicant): Older adults overwhelmingly bear the burden of high blood pressure, a condition strongly associated not only with cardiovascular disease, but also with cognitive decline. As life expectancy improves, preservation of cognition in older age has become increasing important to patients, their care givers, and public health. A recent report from the JNC8 committee members suggested liberalizing clinic-based systolic blood pressure targets in persons > 60 years to < 150mmHg compared to < 140mmHg previously, due to lack of data and unproven benefits at lower levels, but this recommendation is being actively debated. Targets for hypertension control and their downstream effects on cognition are the subject of ongoing investigation in SPRINT (Systolic Blood Pressure Intervention Trial), a large, multi-center trial of intensive (<120 systolic) vs. standard (<140 systolic) blood pressure targets in > 9350 hypertensive individuals. Targets in SPRINT (as in the majority of hypertension studies) are based on in-clinic blood pressures. However, `hypertension' is a dynamic phenomenon: 24-hour ambulatory blood pressure (ABPM) patterns, in particular loss of nocturnal dipping (high night/day blood pressure ratio), have been well studied in the cardiovascular literature. My preliminary data supported by my K23-funded observational cohort of healthy older adults suggests that loss of nocturnal dipping and diastolic hypotension on ABPM measurements are associated with worse cognitive function. These associations were not evident using clinic based blood pressure measurements. If confirmed, ABPM measurements could inform the recent debate about the appropriate blood pressure target in older adults. Different in-clinic treatment targets may differentially impact 24-hour blood pressure patterns, and therefore cognitive function. An ongoing already funded SPRINT ancillary study is collecting ABPM readings in a subset of 600 participants in SPRINT with the main goal of evaluating nocturnal BP patterns in the two arms of SPRINT. We are already collaborating with these investigators, however existing funding does not cover the analysis of cognitive function outcomes. This R03 will support analysis to evaluate whether lower diastolic blood pressure and less dipping are associated with cognitive decline in SPRINT, as in our pilot data. We will test whether the effect of intensive blood pressure control on cognitive function is affected by the ABPM pattern achieved with treatment. This low-cost, high-impact study has the opportunity to directly impact hypertension care: if the effect of different treatment targets on cognition can be predicted by the observed ABPM while taking anti-hypertensive treatment, obtaining ABPM in hypertensive older adults would likely become an important part of standard medical practice.

 描述（由适用提供）：老年人压倒性地承受着高血压的燃烧，这种疾病不仅与心血管疾病密切相关，而且与认知能力下降有关。随着预期寿命的提高，对患者，护理人员和公共卫生的认知保留变得越来越重要。 JNC8委员会成员最近的一份报告建议，由于缺乏数据和较低水平的未经证实的益处，与以前<140mmHg相比，基于诊所的收缩压靶标在> 60岁至<150mmHg的人中易于自由化，但该建议正在积极进行辩论。高血压控制的靶标及其对认知的下游影响是Sprint（收缩压干预试验）正在进行的研究的主题，这是一项大型，多中心的强化（<120收缩期）与标准的试验（<140收缩期）血压目标 在> 9350个高血压个体中。 Sprint中的靶标（如大多数高血压研究中）是基于临界血压的。然而，“高血压”是一种动态现象：24小时的卧床血压（ABPM）模式，特别是夜间浸润（高夜/白天血压比），在心血管文献中已经很好地研究了。我的K23资助的健康老年人的观察队列支持的我的初步数据表明，在ABPM测量中失去夜间浸润和舒张压低血压与认知功能较差有关。这些关联不是使用基于诊所的血压测量的证据。如果得到确认，ABPM测量结果可能会告知最近破坏老年人的适当血压目标。不同的临床治疗靶标可能会对24小时的血压模式产生不同的影响，从而影响认知功能。一项正在进行的已经有资助的Sprint辅助研究是在Sprint中收集了600名参与者的子集，其主要目标是评估Sprint两个臂中的夜间BP模式。我们已经与这些研究人员合作，但是现有的资金并不能涵盖对认知功能结果的分析。该R03将支持分析，以评估较低的舒张压和降低降低是否与Sprint的认知能力下降有关，如我们的Pilot数据。我们将测试强化血压控制对认知功能的影响是否受到治疗实现的ABPM模式的影响。这项低成本，高影响力的研究有机会直接影响高血压护理：如果观察到的ABPM可以预测不同治疗靶标的对认知的影响，同时接受抗高血压治疗，那么在高血压老年人中获得ABPM可能会成为标准医学实践的重要组成部分。