자료유형  

 학위논문

Control Number  

0017163735

International Standard Book Number  

9798342115667

Dewey Decimal Classification Number  

616

Main Entry-Personal Name  

Liu, Xiaojuan.

Publication, Distribution, etc. (Imprint  

[S.l.] : Stanford University., 2024

Publication, Distribution, etc. (Imprint  

Ann Arbor : ProQuest Dissertations & Theses, 2024

Physical Description  

174 p.

General Note  

Source: Dissertations Abstracts International, Volume: 86-04, Section: A.

General Note  

Advisor: Odden, Michelle.

Dissertation Note  

Thesis (Ph.D.)--Stanford University, 2024.

Summary, Etc.  

요약Hypertension management remains a challenging problem in older adults. Randomized clinical trials including relatively healthier older adults have shown benefits of intensive blood pressure control, while they have excluded nursing home residents. Intensive antihypertensive treatment may no longer be beneficial in this frail subpopulation given their vulnerability to adverse effects and shorter life expectancy. Consequently, antihypertensive deprescribing or discontinuation is of growing interest. However, limited evidence exists on the impact of antihypertensive deprescribing on patient-centered outcomes to guide clinical practice. On the other hand, functional status, which is defined as the levels of activities performed by an individual to realize the needs of daily living, emerges a focus in clinical care for older people. Gathering more data on the associations between antihypertensive treatment and functional status could inform personalized care plans and optimize treatment strategies. Moreover, a deeper understanding of the biological mechanisms and identification of translational biomarkers could shed light on the prevention of functional decline. This dissertation links together three diverse projects with the overarching goal to understand the relationships of blood pressure, antihypertensive treatment, cardiovascular and functional outcomes in nursing home residents and identify biomarkers and mechanisms underlying physical functional decline over life course. To achieve this, we leverage multiple data sources, advanced platforms, and a variety statistical and epidemiological methods in these projects. First, we assessed the associations of systolic blood pressure level with cardiovascular and mortality risk in Veterans Affairs (VA) nursing home residents and uncovered that these associations varied by the intensity of antihypertensive medications. Second, we leveraged VA electronic health records and emulated a target trial on antihypertensive deprescribing and found that deprescribing antihypertensive medication did not adversely affect functional status. Finally, we performed a proteomic analysis and identified a novel set of plasma proteins associated with functional decline in gait speed and grip strength from middle to old age. Collectively, these studies could contribute to an enhanced understanding of the hypertension management in older nursing home residents, as well as the biological mechanisms of physical decline to inform the health improvements and shared decision-making in the older population.

Subject Added Entry-Topical Term  

Cardiovascular disease.

Subject Added Entry-Topical Term  

Biomarkers.

Subject Added Entry-Topical Term  

Frailty.

Subject Added Entry-Topical Term  

Life expectancy.

Subject Added Entry-Topical Term  

Older people.

Subject Added Entry-Topical Term  

Mortality.

Subject Added Entry-Topical Term  

Chronic illnesses.

Subject Added Entry-Topical Term  

Activities of daily living.

Subject Added Entry-Topical Term  

Aging.

Subject Added Entry-Topical Term  

Gerontology.

Subject Added Entry-Topical Term  

Health sciences.

Subject Added Entry-Topical Term  

Medicine.

Subject Added Entry-Topical Term  

Public health.

Added Entry-Corporate Name  

Stanford University.

Host Item Entry  

Dissertations Abstracts International. 86-04A.

Electronic Location and Access  

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Control Number  

joongbu:655064