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 #
5P01HL047540-20
Application #
8628145
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
2014-03-01
Budget End
2015-02-28
Support Year
20
Fiscal Year
2014
Total Cost
$2,519,131
Indirect Cost
$734,389
Name
Columbia University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
621889815
City
New York
State
NY
Country
United States
Zip Code
10032
Kent, Shia T; Bromfield, Samantha G; Burkholder, Greer A et al. (2016) Ambulatory Blood Pressure Monitoring in Individuals with HIV: A Systematic Review and Meta-Analysis. PLoS One 11:e0148920
Booth 3rd, John N; Muntner, Paul; Diaz, Keith M et al. (2016) Evaluation of Criteria to Detect Masked Hypertension. J Clin Hypertens (Greenwich) 18:1086-1094
Beatty Moody, Danielle L; Waldstein, Shari R; Tobin, Jonathan N et al. (2016) Lifetime racial/ethnic discrimination and ambulatory blood pressure: The moderating effect of age. Health Psychol 35:333-42
Abdalla, Marwah; Booth 3rd, John N; Diaz, Keith M et al. (2016) Hypertension and alterations in left ventricular structure and geometry in African Americans: the Jackson Heart Study. J Am Soc Hypertens 10:550-558.e10
Shimbo, Daichi; Abdalla, Marwah; Falzon, Louise et al. (2016) Studies comparing ambulatory blood pressure and home blood pressure on cardiovascular disease and mortality outcomes: a systematic review. J Am Soc Hypertens 10:224-234.e17
Tanner, Rikki M; Shimbo, Daichi; Seals, Samantha R et al. (2016) White-Coat Effect Among Older Adults: Data From the Jackson Heart Study. J Clin Hypertens (Greenwich) 18:139-45
Schwartz, Joseph E; Burg, Matthew M; Shimbo, Daichi et al. (2016) Clinic Blood Pressure Underestimates Ambulatory Blood Pressure in an Untreated Employer-Based US Population: Results From the Masked Hypertension Study. Circulation 134:1794-1807
Abdalla, Marwah; Booth 3rd, John N; Seals, Samantha R et al. (2016) Masked Hypertension and Incident Clinic Hypertension Among Blacks in the Jackson Heart Study. Hypertension 68:220-6
Booth 3rd, John N; Muntner, Paul; Abdalla, Marwah et al. (2016) Differences in night-time and daytime ambulatory blood pressure when diurnal periods are defined by self-report, fixed-times, and actigraphy: Improving the Detection of Hypertension study. J Hypertens 34:235-43
Abdalla, Marwah; Goldsmith, Jeff; Muntner, Paul et al. (2016) Is Isolated Nocturnal Hypertension A Reproducible Phenotype? Am J Hypertens 29:33-8

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