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

描述(由申请者提供)：应聘者和职业发展计划摘要。里夫金博士是一名肾病学家，对老年人的护理有着浓厚的兴趣。她有流行病学背景，在肾病研究员培训期间，她研究了肾功能异常对老年人衰老和心血管疾病的影响。在拟议的职业发展奖期间，她计划在一群居住在社区的老年人中探索高血压、衰老、肾功能以及认知和身体功能障碍的问题。她还计划在同时患有高血压和肾脏疾病的队列中研究适当用药的障碍。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，并发展成为一名独立研究员，从事以患者为导向的老年人肾脏疾病研究。里夫金博士的这笔赠款的指导团队包括心血管流行病学、肾脏病、高血压和老年病学以及生物静力学和卫生服务方面的专家。除了与这一群体的定期会议外，里夫金博士还打算在颁奖过程中在当地机构和全国会议上进行流行病学、卫生服务、高血压和老年病学的正式课程。研究计划摘要。老年人压倒性地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，由于一系列复杂和鲜为人知的障碍，老年人和那些患有肾脏疾病等并发症的人最有可能患上控制不佳的高血压。此外，老年人的“高血压”是一种动态现象，时时刻刻、昼夜都在变化。24小时动态血压异常(ABPM)模式，特别是夜间血压正常模式的丧失，在心血管文献中已经得到了很好的研究，并且与办公室血压测量相比，与心血管疾病的预后更密切相关，但关于当代多民族老年人中其他异常ABPM模式(脉压变异性、低血压和动脉僵硬指数)与肾脏疾病、认知和身体功能障碍的相关性的数据缺乏。对这些关联的更好理解将为老年人的高血压治疗目标提供信息。这项建议的目标是获得ABPM测量，并对400名60岁以上的社区居住的白人、非裔美国人、西班牙裔和亚洲成年人进行肾功能、身体功能和认知表现的系列评估。我们将在这个不同的老年人队列中评估ABPM模式与肾脏疾病标记物之间的关系，调查ABPM模式是否与该人群中的不成功衰老(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衰老的发展的纵向相关性。最后，我们将调查队列中的一部分人群对肾脏疾病和高血压的态度和知识以及用药模式，并针对患有CKD的老年人编制用药依从性和知识问卷。

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.