Research completed under this Program Project Grant has identified """"""""masked hypertension"""""""" (MHT), a condition associated with target organ damage and significantly increased cardiovascular risk. MHT is defined by BP that is normal in the clinic but hypertensive (HT) during the day, possibly the result of higher psychological stress, delayed recovery from this pressor stimulus, or both. Functional changes in cardiovascular (CV) regulation may characterize MHT, and in turn contribute to the development of essential HT. We view MHT as an intermediate phase between NT and HT, and a potentially invaluable focus for revealing the developmental pathophysiology of HT.
The Specific Aim of Project 2 is to examine physiological and psychological factors associated with delayed post-stress BP recovery, the process we hypothesize contribute to the high daytime BP that is characteristic of MHT. In the laboratory we will study the reactivity to and recovery from anger recall stress in equal numbers of subjects with MHT and sustained normotension (SNT) (n=85/group, selected from Project 1). We will obtain physiological measures of CV regulation, and psychological measures of emotion and rumination during baseline, stress, and extended recovery periods. We hypothesize that compared to individuals with SNT, those with MHT, 1) will demonstrate a greater increase from baseline to the anger recall task in cardiac output (CO) and total peripheral resistance (TPR), and endothelial dysfunction, the primary contributors to BP, and hence also in BP;2) will demonstrate slower return of these indices to baseline levels during extended observation;and; 3) this slower return to baseline among MHT subjects during extended observation will be partially mediated by the occurrence of angry rumination during that period. We will also examine whether autonomic (BP variability, RR interval variability [RRV], catecholamines) and associated biological (Cortisol, endothelin-1, inflammation, oxidative stress) indices of vascular integrity and function demonstrate a comparable pattern of reactivity to and recovery from anger recall as that seen for BP, CO, TPR, and endothelial function.

Public Health Relevance

Significance. Over 28% of US adults have a diagnosis of essential HT. Despite best efforts using current research models, it remains a leading cause of death and disability. In this application, we propose to use the model of MHT, an intermediate condition that afflicts upwards of an additional 20 million people, to identify the pathophysiological processes that distinguish MHT from SNT. We believe that this approach will identify key factors that are dysregulated in MHT and in so doing will contribute to the eariier identification and improved prognosis of individuals who are on a trajectory to essential HT.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Program Projects (P01)
Project #
Application #
Study Section
Special Emphasis Panel (ZHL1-PPG-Z)
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Columbia University (N.Y.)
New York
United States
Zip Code
Shaffer, Jonathan A; Kronish, Ian M; Falzon, Louise et al. (2018) N-of-1 Randomized Intervention Trials in Health Psychology: A Systematic Review and Methodology Critique. Ann Behav Med 52:731-742
Taggart Wasson, Lauren; Shaffer, Jonathan A; Edmondson, Donald et al. (2018) Posttraumatic stress disorder and nonadherence to medications prescribed for chronic medical conditions: A meta-analysis. J Psychiatr Res 102:102-109
Edmondson, Donald; Sumner, Jennifer A; Kronish, Ian M et al. (2018) The Association of Posttraumatic Stress Disorder With Clinic and Ambulatory Blood Pressure in Healthy Adults. Psychosom Med 80:55-61
Diaz, Keith M; Krupka, David J; Chang, Melinda J et al. (2018) Wrist-based cut-points for moderate- and vigorous-intensity physical activity for the Actical accelerometer in adults. J Sports Sci 36:206-212
Bromfield, Samantha G; Booth 3rd, John N; Loop, Matthew S et al. (2018) Evaluating different criteria for defining a complete ambulatory blood pressure monitoring recording: data from the Jackson Heart Study. Blood Press Monit 23:103-111
Kronish, I M; Edmondson, D; Shimbo, D et al. (2018) A Comparison of the Diagnostic Accuracy of Common Office Blood Pressure Monitoring Protocols. Am J Hypertens :
Anstey, D Edmund; Muntner, Paul; Bello, Natalie A et al. (2018) Diagnosing Masked Hypertension Using Ambulatory Blood Pressure Monitoring, Home Blood Pressure Monitoring, or Both? Hypertension 72:1200-1207
Bello, Natalie A; Schwartz, Joseph E; Kronish, Ian M et al. (2018) Number of Measurements Needed to Obtain a Reliable Estimate of Home Blood Pressure: Results From the Improving the Detection of Hypertension Study. J Am Heart Assoc 7:e008658
Cornelius, Talea; Birk, Jeffrey L; Edmondson, Donald et al. (2018) Romantic Relationship Satisfaction and Ambulatory Blood Pressure During Social Interactions: Specificity or Spillover Effects? Ann Behav Med :
Cornelius, Talea; Birk, Jeffrey L; Edmondson, Donald et al. (2018) The joint influence of emotional reactivity and social interaction quality on cardiovascular responses to daily social interactions in working adults. J Psychosom Res 108:70-77

Showing the most recent 10 out of 200 publications