Race / Ethncicity, Hypertension and Prevention of VCID and Stroke after Intracerebral Hemmorrhage

项目总结 脑出血(ICH)几乎占中风相关发病率和死亡率的一半。在非物质文化遗产中 幸存者中，近2/3会出现认知功能下降，表现为血管功能减退 认知障碍和痴呆(VCID)，或5年内复发中风。这种快速的功能衰退， 潜在性脑小血管疾病(CSVD)的进展结果加速了Black和 西班牙裔非物质文化遗产幸存者，造成了巨大的健康差距。因此，阻止这一进程将使 承诺显著改善美国每年5万名非物质文化遗产幸存者的结果，并纠正 相当大的健康不平等。 血压升高是脑出血后发生VCID和卒中的最有效的预测因子。然而&gt；50%的 ICH幸存者在脑出血后患有未经治疗的高血压，黑人和 西班牙裔病人。改善中风后的BP控制仍然是一个持久的挑战。BP的临床试验 降低计划还没有显示出效果。一个主要的障碍是未能让患者参与到 程序。健康的社会决定因素(SDOH)，塑造日常生活的更广泛的一组力量和系统， 是大多数疾病的风险因素，也是种族/族裔健康不平等的关键因素。 尽管如此，还没有关于非物质文化遗产中SDOH的系统研究，这在知识上留下了一个关键的空白。 本更新提案的总体目标，题为种族/族裔、高血压和预防 脑出血后VCID和卒中的研究是建立在即将结束的复发性出血性卒中结果的基础上 在少数群体中(R01NS093870)研究并填补知识方面的空白，这是告知 设计未来干预措施以加强BP控制并消除VCID和复发性疾病中的种族/民族不平等 脑出血后卒中。关键的下一步是确定对以下方面影响最大的潜在可修改SDOH 1)脑出血后VCID和再发卒中；2)高血压失控率；3)策略参与度 来降低血压。 我们将招募并纵向跟踪700名非物质文化遗产幸存者，他们分为黑人、西班牙裔、白人和亚洲人 所有人都将接受英国石油公司管理的标准化、最先进的循证计划。 我们试图：1)确定可改变的SDOH是否与既定的生物因素相关，预测 脑出血后VCID和复发中风的风险增加；2)确定可修改的SDOH是否可以预测 脑出血后高血压控制不佳；3)确定可改变的SDOH是否与降低有关 参与我们的标准化BP管理计划。所产生的数据将用于开发新的 血压管理和预防VCID和脑出血后再发中风的策略，并可能有 对预防CSVD相关的VCID和中风的影响，即使在那些没有经历过脑出血的人中也是如此。

PROJECT SUMMARY Intracerebral hemorrhage (ICH) accounts for almost half of stroke-related morbidity and mortality. Among ICH survivors, nearly 2/3 will develop either incident cognitive decline, in the form of Vascular contributions to Cognitive Impairment and Dementia (VCID), or recurrent stroke within 5 years. This rapid functional decline, the result of progression of underlying Cerebral Small Vessel Disease (CSVD), is accelerated for Black and Hispanic ICH survivors, yielding a substantial health disparity. Arresting this progression therefore holds the promise of markedly improving outcomes for the >50,000 ICH survivors annually in the US and correcting a considerable health inequity. Elevated Blood Pressure (BP) is the most potent predictor of incident VCID and stroke after ICH. Yet >50% of ICH survivors have untreated hypertension after their ICH, with substantially higher rates among Black and Hispanic patients. Improving BP control following stroke remains a persistent challenge. Clinical trials of BP lowering programs have not demonstrated efficacy. A chief obstacle has been a failure to engage patients in the programs. Social determinants of health (SDOH), the wider set of forces and systems shaping daily life, contribute to risk for most medical conditions, and are key contributors to race/ethnic health inequities. Nonetheless, there have been no systematic studies of SDOH in ICH, leaving a crucial gap in knowledge. The overarching goal of the present renewal proposal, entitled Race / Ethnicity, Hypertension and Prevention of VCID and Stroke after ICH, is to build on the results of the soon-to-conclude Recurrent Hemorrhagic Stroke in Minority Populations (R01NS093870) study and fill gaps in the knowledge that is essential for informing the design of future interventions to enhance BP control and eliminate racial/ethnic inequities in VCID and recurrent stroke after ICH. The crucial next step is identifying potentially modifiable SDOH that have the highest impact on 1) post-ICH VCID and recurrent stroke; 2) rates of uncontrolled hypertension, and 3) engagement with strategies to lower BP. We will enroll and follow longitudinally 700 ICH survivors divided among Black, Hispanic, White, Asian individuals, all of whom will receive a standardized state-of-the-art evidence-based program of BP management. We seek to: 1) determine whether modifiable SDOH in association with established biological factors, predict increased risk for VCID and recurrent stroke after ICH; 2) determine whether modifiable SDOH predict risk of poor hypertension control after ICH; 3) determine whether modifiable SDOH are associated with decreased engagement with our standardized BP management program. The data generated will be used to develop novel strategies for BP management and prevention of VCID and recurrent stroke after ICH, and are likely to have implications for preventing CSVD-related VCID and stroke, even in those who have not suffered an ICH.