Ambulatory BP, kidney function, cognitive & physical function in older adults

描述（由申请人提供）：候选人和职业发展计划概述。里夫金博士是一位对老年人护理有浓厚兴趣的肾病专家。她有流行病学背景，并在肾病学奖学金培训期间研究了老年人肾脏功能异常对衰老和心血管疾病的影响。在拟议的职业发展奖期间，她计划在一群社区居住的老年人中探索高血压、衰老、肾功能、认知和身体功能障碍等问题。她还计划研究同时患有高血压和肾脏疾病的人群中适当使用药物的障碍。她计划在获奖期间发展她在患者招募、流行病学、老年病学和卫生服务方面的技能，并发展成为一名以患者为导向的老年人肾病研究的独立研究员。Rifkin博士的指导团队包括心血管流行病学、肾脏病学、高血压学、老年病学以及生物静力学和卫生服务方面的专家。除了与这个小组定期会面外，Rifkin博士打算在获奖期间在地方机构和国家会议上学习流行病学、保健服务、高血压和老年病学方面的正式课程。研究计划总结。绝大多数老年人承受着高血压和肾脏疾病的负担，这些疾病与心血管疾病以及身体和认知能力下降密切相关。然而，老年人和那些有合并症（如肾脏疾病）的人最有可能患有控制不佳的高血压，这是由于一系列复杂且知之甚少的障碍。此外，老年人的“高血压”是一种动态现象，每时每刻、不分昼夜都在变化。异常的24小时动态血压（ABPM）模式，特别是夜间正常低血压模式的丧失，已经在心血管文献中得到了充分的研究，并且与办公室血压测量结果相比，与CVD结局的关系更密切，但是其他异常ABPM模式（脉压变异性、低血压和动脉僵硬指数）与肾脏疾病、认知、认知、当代多民族老年人缺乏身体功能障碍。更好地了解这些关联将为老年人的高血压治疗目标提供信息。本研究的目的是对400名60岁以上的社区白人、非裔美国人、西班牙裔和亚裔成年人进行ABPM测量和肾功能、身体功能和认知能力的系列评估。我们将在这一多样化的老年人队列中评估ABPM模式与肾脏疾病标志物之间的关联，研究ABPM模式是否与该人群中不成功的衰老（认知功能障碍、身体功能障碍、跌倒和虚弱）独立相关，并评估ABPM与肾功能下降和不成功的衰老发展之间的纵向关联。最后，我们将探讨在队列的一个子集中对肾脏疾病和高血压的态度和知识以及药物使用模式，并建立针对老年CKD患者的药物依从性和知识问卷。

DESCRIPTION (provided by applicant): Candidate and career development plan summary. Dr. Rifkin is a nephrologist with a strong interest in the care of older adults. She has a background in epidemiology and during fellowship training in nephrology studied the implications of abnormal kidney function for aging and cardiovascular disease in older adults. During the proposed career development award she plans to explore issues of hypertension, aging, kidney function, and cognitive and physical dysfunction in a cohort of community-dwelling older adults. She also plans to study barriers to appropriate medication use among a subset of the cohort who have both hypertension and kidney disease. She plans to develop her skills in patient recruitment, epidemiology, geriatrics, and health services during the term of the award and develop into an independent researcher in patient-oriented studies of older adults with kidney disease. Dr Rifkin's mentorship team for this grant includes experts in cardiovascular epidemiology, nephrology, hypertension, and geriatrics as well as biostatics and health services. Along with regular meetings with this group, Dr. Rifkin intends to pursue formal coursework in epidemiology, health services, hypertension and geriatrics both at local institutions and at national meetings during the course of the award. Research Plan summary. Older adults overwhelmingly bear the burden of hypertension and kidney disease, conditions that are strongly associated with CVD and physical and cognitive decline. Yet older individuals and those with comorbidities such as kidney disease are amongst those most likely to have poorly controlled hypertension, due to a complex and poorly understood constellation of barriers. Furthermore, 'hypertension' in older adults is a dynamic phenomenon that varies from moment to moment and throughout the day and night. Abnormal 24- hour ambulatory blood pressure (ABPM) patterns, in particular loss of the normal pattern of lower blood pressure at night, have been well-studied in the cardiovascular literature and are more closely linked to CVD outcomes than office blood pressure measurements, but data on associations of other abnormal ABPM patterns (pulse pressure variability, hypotension, and arterial stiffness indices) with kidney disease, cognitive, and physical dysfunction in contemporary multiethnic elders are lacking. A better understanding of these associations would inform hypertension treatment goals for older adults. The objective of this proposal is to obtain ABPM measurements and serial assessments of kidney function, physical function, and cognitive performance in a well-characterized population of 400 community-dwelling white, African-American, Hispanic, and Asian adults over 60 years of age. We will evaluate associations between ABPM pattern and kidney disease markers in this diverse cohort of older adults, investigate whether ABPM pattern is independently associated with unsuccessful aging (cognitive dysfunction, physical dysfunction, falls, and frailty) in this population, and assess longitudinal associations of ABPM with decline in kidney function and development of unsuccessful aging. Finally, we will explore the attitudes and knowledge about kidney disease and hypertension and the medication use patterns among a subset of the cohort and build a medication adherence and knowledge questionnaire directed at older adults with CKD.