Chronic Lower Leg Heating for the Treatment of Hypertension in Older Women

项目总结 老年(≥65岁)女性的高血压患病率高于老年男性，而血液中的 在美国，老年女性的血压控制率较低。失控的高血压是一个主要的 心血管疾病发病率和死亡率的危险因素。尽管标准治疗和坚持使用最理想的药物 方案，超过50%的老年高血压妇女的血压控制仍然不足(例如&gt；140/90毫米汞柱)，以及 随着新的2017年最近建议的更积极的BP目标，控制率进一步降低 ACC/AHA高血压指南。因此，单靠药物治疗在控制肺炎方面的有效性。 老年妇女中的高血压是有限的；因此，也需要非药物方法来帮助。 降低老年高血压妇女的血压和心血管发病率和死亡率。一种佐剂，非- 在降低血压方面有希望的药理方法是“热疗”。的确，反复(慢性) 研究发现，全身热暴露会降低健康人体的血压。这是否也是正确的之后 高血压患者的局部肢体加热尚不清楚。这项研究项目的全球目标 目的：探讨家庭小腿热疗对老年女性高血压患者的降压效果。 高血压，并检查这种治疗方式对神经血管健康的影响 这些病人。特定目标1将检验以下假设：慢性小腿热疗联合 在老年高血压妇女中，降压药物在降低血压方面优于单纯药物治疗。我们会 将老年高血压妇女随机分配到干预组或对照组。医院里的病人 干预组将通过水浸泡进行为期8周的家庭小腿热疗，最高可达 膝关节在循环浴中(水温42°C，每周4次，每次45分钟)，而患者在 对照组将双腿以相同的频率浸泡在33°C的温中温水浴中， 持续时间。所有患者还将接受固定剂量的氯苯吡酮(利尿剂，每天口服一次，25毫克)。我们 将比较动态血压、血压控制率以及患者对治疗的依从性和可接受性 在这两组人之间。《特定目标2》将检验慢性小腿热疗将会改善的假设。 一氧化氮降低交感神经收缩及改善血管功能的生物利用度 老年高血压女性。我们将使用最先进的显微神经学技术，多普勒超声， 压平眼压测量和皮肤微透析评估交感神经控制，导管指数 和阻力血管扩张功能，以及间质代谢物(即硝酸盐和亚硝酸盐)指示的基础 所有纳入AIM 1的患者在热疗前和热疗后8周的一氧化氮生物利用度。信息 本研究项目得出的结论将指导循证临床实践。预计我们的研究 可能导致修订高血压指南，将家庭热疗作为辅助 老年女性以及其他患者人群使用的降压药(S)。

PROJECT SUMMARY The prevalence of hypertension is greater in older (≥65 years) women than in older men, while the blood pressure (BP) control rate is lower in older women in the United States. Uncontrolled hypertension is a major risk factor for cardiovascular morbidity and mortality. Despite standard therapy and adherence to optimal drug regimens, over 50% of older hypertensive women still have inadequate BP control (e.g. >140/90 mmHg), and the control rate is further reduced with more aggressive BP targets recommended recently by the new 2017 ACC/AHA Hypertension Guidelines. Thus, the effectiveness of drug treatment alone in the control of hypertension among older women is limited; hence, non-pharmacological approaches are also needed to help reduce BP and cardiovascular morbidity and mortality in older hypertensive women. One adjuvant, non- pharmacological approach that offers promise in lowering BP is “heat therapy”. Indeed, repeated (chronic) whole-body heat exposure has been found to decrease BP in healthy humans. Whether this is also true after regional limb heating in hypertensive patients is unknown. The global objectives of this research project are to investigate the BP lowering effect of home-based lower leg heat therapy in older women with hypertension, and to examine the impact of this therapeutic modality on neural-vascular health in these patients. Specific Aim 1 will test the hypothesis that chronic lower leg heat therapy combined with an antihypertensive drug is superior to drug treatment alone in lowering BP in older hypertensive women. We will randomly assign older hypertensive women to either an intervention group or a control group. Patients in the intervention group will perform 8 weeks of home-based lower leg heat therapy via water immersion up to the knee in a circulated bath (water temperature 42°C, 4 times per week, 45 min per session), whereas patients in the control group will immerse their legs in a thermoneutral water bath (33°C) at the same frequency and duration. All patients will also receive a fixed dose of chlorthalidone (a diuretic, 25 mg orally once daily). We will compare ambulatory BP, the BP control rate, and patient adherence and acceptability to treatment between the groups. Specific Aim 2 will test the hypothesis that chronic lower leg heat therapy will improve nitric oxide bioavailability which can decrease sympathetic vasoconstriction and improve vascular function in older hypertensive women. We will use state-of-the-art techniques of microneurography, Doppler ultrasound, applanation tonometry, and cutaneous microdialysis to assess sympathetic neural control, indices of conduit and resistance vessel vasodilator function, and interstitial metabolites (i.e. nitrate and nitrite) indicative of basal nitric oxide bioavailability in all patients enrolled in Aim 1 before and after 8 weeks of heat therapy. Information obtained from this research project will guide evidence-based clinical practice. It is anticipated that our study may lead to revision of hypertension guidelines to incorporate home-based heat therapy as adjuvant to antihypertensive drug(s) for older women, as well as other patient populations.