Systolic Blood Pressure Variability and Multiple Sclerosis Disease Progression
Abstract
Over 25% of individuals with multiple sclerosis (MS) also suffer from one or more co-morbid conditions. Individuals with both MS and comorbid diseases are at an increased risk of delay in diagnosis, MS relapse, disease progression, reduced quality of life, and increased socio-economic burdens. Among co-morbid diseases, vascular comorbidities and related risk factors including hypertension, hyperlipidemia, obesity, and smoking are associated with higher cross-sectional disability and patient-reported worsening of disability. Recently, there is emerging evidence that individuals with excessive fluctuations in blood pressures will over time experience poorer health outcomes compared to those without these blood pressure changes. Research suggests the effect of this excessive blood pressure variability (SBPv) is independent of average blood pressure values and can occur in individuals with both normal blood pressure and known hypertension. In aging adults, this type of blood pressure change is linked to cognitive decline. SBPv is associated with cognitive dysfunction in Parkinson s disease, another neurologic disease. Preliminary studies of SBPv in MS patients demonstrate that those with excessive SBPv have increased self-reported MS disability. This important aspect of physical health is yet to be fully explored in MS and merits further study, which we propose in this application. A clearer understanding of the impact of vascular comorbidities on MS disease progression is an important step, but an equally important gap in our current knowledge is what impact treating these comorbidities will have on MS disease progression. Using a novel mathematical model, we can estimate the benefit treating vascular comorbidities will have on individuals living with MS. By studying the effects of vascular comorbidities, this proposal is directly responsive to the Focus Area Correlates of Disease Activity and Progression in Multiple Sclerosis. Many of the studies looking at comorbidities and MS have been done in insurance claim data sets from hospitals and clinics. These data are known to have several limitations. As a consequence, the full impact of vascular comorbidities on MS disease progression remains uncertain. To address the limitations of previous work and expand our understanding, we propose a study that addresses the following three questions: (1) What is the longitudinal impact of vascular comorbidities and related risk factors in clinical disease progression in MS; (2) What is the impact of SBPv (a likely unrecognized vascular risk factor) in MS disease; (3) Does treatment of vascular comorbidities mitigate MS outcomes? Our study will overcome the limitations of previous research by utilizing combined data for about 1,200 subjects from three phase 2 and 3 MS clinical trials. These data include both relapsing and progressive populations and cover patients across the full MS-disease spectrum. These trials all evaluated patients in 3-month intervals for a wide range of MS-related outcomes, including patient-reported outcomes, and will allow us to follow up 2-year longitudinal outcomes. These data have already been acquired by our research team. Our proposed study represents the largest longitudinal assessment of vascular comorbidities and related risk factors in MS disease progression. Using novel mathematical modeling, this study will also provide first-ever insights into the therapeutic impact of managing these conditions for MS patients. Our work will provide critical and actionable information that has implications for clinical practice in the short term and scientific knowledge base to build on for future improvements in care for individuals living with MS.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 28, 2022
- Source ID
- W81XWH2210955
Entities
People
- Min-woong Sohn
Organizations
- United States Army
- University of Kentucky