The proposed research builds on exciting findings from the research conducted during the current period of funding. Our existing Program Project (PPG;P01 HL47540), now beginning its 16* year of funding, focuses on the role of psychosocial factors in the development of hypertension (HT) and cardiovascular disease (CVD). It comprises a body of work that has been supported continuously by NHLBI since 1988 (originally an R01), conducted by a well-established, multidisciplinary group of investigators at the Columbia University Medical Center (CUMC) and Stony Brook University. We have identified """"""""Masked Hypertension,"""""""" (MHT) the condition in which one has normal clinic blood pressure (BP) but an average daytime ambulatory BP above the threshold for hypertension. Although MHT is not diagnosed by conventional BP measurement criteria, it is associated, cross-sectionally, with increased target organ damage. We believe MHT to be of great clinical, etiological, and public health significance, as it is likely a highly prevalent condition, present in as many as 20 million Americans. The proposed PPG will investigate the contribution of MHT to la) future increases in blood pressure (BP) and lb) progression of target organ damage (Project 1, a prospective cohort study), 2) the psychophysiological mechanism(s) associated with MHT (Project 2, a psychophysiology laboratory reactivity/recovery mechanistic study), and 3) strategies to improve the diagnosis of hypertension in a costeffective manner (Project 3, a decision science study). This research program is crucial if those with MHT are to be cost-effectively identified for further monitoring and/or treatment, and if we are to understand MHT's mechanisms and clinical sequelae. Participants in our current MHT Study will be followed prospectively, with some being recruited to also participate in Project 2. Participants for Project 3 will be recruited from the general population and the primary care clinics of CUMC. They will constitute a new sample, over-sampling those with pre-hypertension or untreated Stage 1 hypertension by clinical BP criteria. This proposed P01 will address the NHLBI aims and goals by substantially increasing our understanding of the clinical sequelae of MHT and the mechanisms underlying this condition, and by applying a decision science approach to the development of a substantially improved algorithm for diagnosing hypertension and identifying those who are most likely to benefit from treatment. We believe that our findings are likely to have a major impact on the methods used to measure BP routinely in clinical practice.

Public Health Relevance

In this application we focus on the behavioral aspects of an issue of major public health importance: Masked HTN (MHTN). A central tenet of our research is that conventional methods of measuring BP seriously misclassify the HTN status of many people, and that ambulatory BP monitoring (ABPM) gives a better prediction of CVD risk and the effects of stress.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Program Projects (P01)
Project #
5P01HL047540-19
Application #
8445368
Study Section
Special Emphasis Panel (ZHL1-PPG-Z (M2))
Program Officer
Czajkowski, Susan
Project Start
1994-09-01
Project End
2015-02-28
Budget Start
2013-03-01
Budget End
2014-02-28
Support Year
19
Fiscal Year
2013
Total Cost
$2,423,545
Indirect Cost
$640,349
Name
Columbia University (N.Y.)
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
621889815
City
New York
State
NY
Country
United States
Zip Code
10032
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