Arterial Stiffness and Blood Pressure

Más betegség

• Participants who have an indication for a specific BP lowering medication that is not included in the study protocol or a known secondary cause of hypertension will be excluded.
• The investigators will also exclude those with factors that may limit adherence to the study interventions or follow-up including active substance abuse, plans to move outside the study catchment areas within 12 months or a history of poor medication adherence or clinic no-shows

Laborértékek

• Patients will be excluded if they have:
  • a standing SBP <110 mmHg
  • past history of a recent CVD event in the past 12 months (i.e., coronary artery disease event/intervention, congestive heart failure exacerbation or heart failure hospitalization, atrial fibrillation, or peripheral arterial disease intervention)
  • a class I indication for betablocker use including atrial arrhythmias
  • left-ventricular systolic function <50%, >moderate aortic stenosis
  • history of stroke
  • chronic kidney disease (eGFR<30 mL/min/m2) or proteinuria in excess of 1 gram/day or polycystic kidney disease
  • active cancer (other than untreated, non-metastatic prostate cancer and non-melanoma skin cancer)
  • hypoxemic pulmonary disease
  • active rheumatologic or connective tissue diseases (i.e., systemic lupus erythematosus, rheumatoid arthritis, etc.)
  • human immunodeficiency virus
  • illness with any infectious etiology or fever >38°C (i.e., upper respiratory illness, gastrointestinal illness, etc.)
  • hospitalization for any reason within the prior 4 weeks

Egyéb

• Participants will be excluded if arm circumference is too large/small to allow accurate blood pressure recordings

• Male and female participants from VA VISN 7, 9, and 12 will be eligible to participate if they are over age 60 years and have a diagnosis of hypertension or take antihypertensive medications (up to 4).
• Veterans will require documented SBP readings on 2 or more office visits that are 140 mmHg or average home blood pressure readings 135 mmHg to be eligible for the trial.
• Participants must be willing to be randomized to intensive or standard blood pressure treatment and have blood pressure medications adjusted per the study protocol.
• They must be willing to undergo tonometric evaluation of arterial stiffness, and carotid artery ultrasound.