# Clinical Implications of Blood Pressure Patterns Among Older Adults

> **NIH NIH R56** · BETH ISRAEL DEACONESS MEDICAL CENTER · 2020 · $903,833

## Abstract

Hypertension affects nearly 100% of adults over 75 years of age, and the recent Systolic Blood Pressure
Intervention Trial (SPRINT) demonstrated that targeting lower clinic-based blood pressure (BP) measurements
prevented cardiovascular disease (CVD) events in older adults. However, hypotension-related hospitalizations
were among the most significant complications from intensive BP treatment, despite SPRINT's carefully
executed BP measurement protocols. The inability of clinic-based BP to predict hypotensive complications has
led many to question whether lower BP treatment goals based on clinic BP alone are safe in older adults, who
are especially vulnerable to perceived consequences of hypotension, like falls and dementia. While guidelines
recommend that BP treatment be informed by standing clinic-based BP measurements and 24-hour ambulatory
blood pressure monitoring (ABPM) outside of clinic, the prevalence and long-term implications of (1) low BP
upon standing (i.e. orthostatic hypotension [OH]) and (2) large discrepancies between clinic and home BP (“white
coat effects” [WCE]) are under-characterized among older adults.
In this study, we apply our unique expertise with OH assessments and 24-hour ambulatory blood pressure
monitoring (ABPM) to one of the most long-standing and well-respected American cohorts of community-dwelling
adults, the Atherosclerosis Risk in Communities Study (ARIC). Our proposal will assess OH and ABPM in 2,345
black and white adults over age 80 years, establishing possibly the largest prospective study of both OH and
WCE among older adults in the United States. Our aims are to quantify the prevalence of OH and WCE in this
diverse population and determine the association of OH and WCE with longitudinal change in (1) physical
function (balance, gait speed, gait pattern), (2) cognitive function (response time, visuospatial domains), and (3)
highly sensitive markers of subclinical cardiac injury and strain, high sensitivity cardiac troponin T and N terminal
b-type pro natriuretic peptide. Moreover, we will establish the association of OH and WCE with clinical events
related to hypotension – falls, dementia, and CVD – over nearly four years of follow-up.
Finding that OH and WCE in older adults are not associated with falls, dementia, and CVD would challenge
current recommendations to screen for these BP patterns prior to BP treatment initiation or intensification,
mitigating delays to treatment. However, finding that OH and WCE are prevalent and associated with falls,
dementia, and CVD, particularly among those with elevated clinic BP, would confirm a greater role for these
assessments prior to treatment initiation and intensification to avoid adverse events among vulnerable adults.
This proposal will inform guidelines for BP management by filling critical gaps in knowledge related to two BP
patterns that are often cited as reasons to defer intensive therapy in older adults. Ultimately, our proposal directly
answers the call...

## Key facts

- **NIH application ID:** 10241715
- **Project number:** 1R56HL153191-01
- **Recipient organization:** BETH ISRAEL DEACONESS MEDICAL CENTER
- **Principal Investigator:** STEPHEN P JURASCHEK
- **Activity code:** R56 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $903,833
- **Award type:** 1
- **Project period:** 2020-09-25 → 2021-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10241715

## Citation

> US National Institutes of Health, RePORTER application 10241715, Clinical Implications of Blood Pressure Patterns Among Older Adults (1R56HL153191-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10241715. Licensed CC0.

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