Ambulatory Blood Pressure and Cognitive Function in the Systolic Blood Pressure Intervention Trial

 描述(申请人提供)：老年人压倒性地承受着高血压的负担，这种疾病不仅与心血管疾病有关，还与认知能力下降有关。随着预期寿命的提高，老年认知的保存对患者、他们的照顾者和公共健康变得越来越重要。JNC8委员会成员最近的一份报告建议，由于缺乏数据和较低水平的未经证实的益处，将60岁人群的临床收缩压目标放宽至150毫米汞，而不是以前的140毫米汞，但这一建议正在积极辩论中。高血压控制目标及其对认知的下游影响是Sprint(收缩血压干预试验)正在进行的研究的主题，这是一项关于强化(&lt；120收缩)与标准(&lt；140收缩)血压目标的大型多中心试验 In&gt；9350名高血压患者。Sprint的目标(就像大多数高血压研究一样)是基于临床血压的。然而，高血压是一种动态现象：24小时动态血压(ABPM)模式，特别是夜间血压下降(高昼夜血压比)的丧失，在心血管文献中已经得到了很好的研究。我的初步数据得到了我的K23资助的健康老年人观察队列的支持，这些数据表明，在ABPM测量中失去夜间低血压和舒张期低血压与认知功能较差有关。使用基于临床的血压测量，这些关联并不明显。如果得到证实，ABPM测量可能会为最近关于老年人适当血压目标的辩论提供信息。不同的门诊治疗目标可能会对24小时血压模式产生不同的影响，从而影响认知功能。一项正在进行的已经得到资助的Sprint辅助研究正在收集Sprint的600名参与者的ABPM读数，主要目标是评估Sprint两个手臂的夜间血压模式。我们已经在与这些研究人员合作，但现有的资金不包括认知功能结果的分析。R03将支持评估舒张压较低和血压下降较少是否与Sprint中的认知能力下降有关的分析，就像我们的试点数据一样。我们将测试强化血压控制对认知功能的影响是否受到通过治疗实现的ABPM模式的影响。这项低成本、高影响的研究有机会直接影响高血压护理：如果在接受降压治疗的同时，观察到的ABPM可以预测不同治疗目标对认知的影响，那么在高血压老年人中获得ABPM可能会成为标准医疗实践的重要组成部分。

 DESCRIPTION (provided by applicant): Older adults overwhelmingly bear the burden of high blood pressure, a condition strongly associated not only with cardiovascular disease, but also with cognitive decline. As life expectancy improves, preservation of cognition in older age has become increasing important to patients, their care givers, and public health. A recent report from the JNC8 committee members suggested liberalizing clinic-based systolic blood pressure targets in persons > 60 years to < 150mmHg compared to < 140mmHg previously, due to lack of data and unproven benefits at lower levels, but this recommendation is being actively debated. Targets for hypertension control and their downstream effects on cognition are the subject of ongoing investigation in SPRINT (Systolic Blood Pressure Intervention Trial), a large, multi-center trial of intensive (<120 systolic) vs. standard (<140 systolic) blood pressure targets in > 9350 hypertensive individuals. Targets in SPRINT (as in the majority of hypertension studies) are based on in-clinic blood pressures. However, `hypertension' is a dynamic phenomenon: 24-hour ambulatory blood pressure (ABPM) patterns, in particular loss of nocturnal dipping (high night/day blood pressure ratio), have been well studied in the cardiovascular literature. My preliminary data supported by my K23-funded observational cohort of healthy older adults suggests that loss of nocturnal dipping and diastolic hypotension on ABPM measurements are associated with worse cognitive function. These associations were not evident using clinic based blood pressure measurements. If confirmed, ABPM measurements could inform the recent debate about the appropriate blood pressure target in older adults. Different in-clinic treatment targets may differentially impact 24-hour blood pressure patterns, and therefore cognitive function. An ongoing already funded SPRINT ancillary study is collecting ABPM readings in a subset of 600 participants in SPRINT with the main goal of evaluating nocturnal BP patterns in the two arms of SPRINT. We are already collaborating with these investigators, however existing funding does not cover the analysis of cognitive function outcomes. This R03 will support analysis to evaluate whether lower diastolic blood pressure and less dipping are associated with cognitive decline in SPRINT, as in our pilot data. We will test whether the effect of intensive blood pressure control on cognitive function is affected by the ABPM pattern achieved with treatment. This low-cost, high-impact study has the opportunity to directly impact hypertension care: if the effect of different treatment targets on cognition can be predicted by the observed ABPM while taking anti-hypertensive treatment, obtaining ABPM in hypertensive older adults would likely become an important part of standard medical practice.