Ambulatory blood pressure and falls in older treated patients with hypertension

项目总结/摘要 高血压是心血管疾病（CVD）的危险因素，其重要性毋庸置疑。老年人是 在美国，三分之二的60岁以上的成年人患有高血压， 高血压抗高血压药物降低CVD的益处已在以下研究中得到证实： 老年高血压患者。然而，积累的数据表明，抗高血压药物 强化治疗可能与老年高血压患者福尔斯跌倒风险增加有关。随着福尔斯 与接受治疗的老年高血压患者的发病率和死亡率相关，临床医生 警惕加强抗高血压药物在这一人群中。临床血压（BP）是 卫生保健提供者在抗高血压药物决策中使用的因素 强化然而，在诊所环境之外的BP可能低于诊所BP并且具有大的波动 一整天因此，门诊血压可能是与以下因素相关的更具临床相关性的生理指标： 福尔斯。动态血压监测（ABPM）可在24小时内对门诊血压进行量化， 设置. ABPM可用于评估白色被毛效应，定义为临床和 动态血压和白色被毛高血压，定义为临床血压升高，但动态血压未升高 BP. ABPM还可以评估24小时内血压变化的幅度以及餐后血压下降， 餐后血压下降。这项研究的目的是确定是否较大的白色皮毛的影响， 24小时内的血压变异性和其次，餐后血压下降与以下风险增加相关： 福尔斯在接受治疗的老年高血压患者中下降。此外，该研究还将确定人口统计和 与较大的白色大衣效应、血压变异性和餐后血压下降相关的临床因素。到 为了实现这些目标，我们将从Kaiser Permanente Southern加州招募1057名65岁以上的患者 有高血压病史并正在服用降压药的患者。人口统计学，临床 特征、老年评估（虚弱、认知受损、活动能力、功能障碍和身体 性能），并在基线时进行24小时ABPM。福尔斯和严重摔伤（骨折、关节 脱位和脑损伤）将在1年随访期内进行前瞻性评估。当决定 为了加强抗高血压药物治疗，卫生保健提供者和患者面临着以下权衡： 预防CVD事件的潜力与增加福尔斯的可能性。由于门诊BP可能是一个更 与临床BP相比，ABPM作为一种支持跌倒风险的相关生理指标， 为接受治疗的老年高血压患者提供个性化护理。ABPM可能在识别 可以安全地进行抗高血压药物强化治疗的老年高血压患者，或 否则避免。

Project Summary/Abstract Hypertension is a cardiovascular disease (CVD) risk factor of unquestionable importance. Older adults are disproportionally affected by hypertension with two thirds of adults 60+ years of age in the U.S. having hypertension. The CVD reduction benefits of antihypertensive medication have been demonstrated among older adults with hypertension. However, accumulating data suggest antihypertensive medication intensification may be associated with an increased risk of falls among older adults with hypertension. As falls are associated with substantial morbidity and mortality in older treated adults with hypertension, clinicians are wary about intensifying antihypertensive medication in this population. Clinic blood pressure (BP) is among the factors used by health care providers in the decision-making regarding antihypertensive medication intensification. However, BP outside of the clinic setting can be lower than clinic BP and have large fluctuations throughout the day. Therefore, out-of-clinic BP may be a more clinically relevant physiologic measure linked to falls. Ambulatory BP monitoring (ABPM) quantifies out-of-clinic BP over a 24-hour period in the naturalistic setting. ABPM can be used to assess the white coat effect, defined as the difference between clinic and ambulatory BP, and white coat hypertension, defined as having elevated clinic but non-elevated ambulatory BP. ABPM can also assess the magnitude of BP variability over 24 hours as well as postprandial BP decline, the BP decline following meals. The aims of this study are to determine whether a larger white coat effect and BP variability over 24 hours and secondarily, postprandial BP decline are associated with an increased risk of falls among older treated adults with hypertension. Further, the study will also identify the demographic and clinical factors associated with a larger white coat effect, BP variability, and postprandial BP decline. To address these aims, we will enroll 1057 patients 65+ years of age from Kaiser Permanente Southern California who have a history of hypertension and are taking antihypertensive medication. Demographics, clinical characteristics, geriatric assessments (frailty, impaired cognition, mobility, functional impairment and physical performance), and 24-hour ABPM will be performed at baseline. Falls and serious fall injuries (fractures, joint dislocations, and brain injuries) will be assessed prospectively over a 1-year follow-up period. When deciding to intensify antihypertensive medication, health care providers and patients are faced with trade-offs between the potential for preventing CVD events vs. the possibility of increasing falls. As out-of-clinic BP may be a more relevant physiologic measure of fall risk than clinic BP, ABPM holds great promise as a tool to support individualized care for older treated adults with hypertension. ABPM may have an essential role for identifying older adults with hypertension in whom antihypertensive medication intensification can safely be undertaken or otherwise avoided.