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.
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.
|Viera, Anthony J; Lin, Feng-Chang; Tuttle, Laura A et al. (2015) Levels of office blood pressure and their operating characteristics for detecting masked hypertension based on ambulatory blood pressure monitoring. Am J Hypertens 28:42-9|
|Diaz, Keith M; Tanner, Rikki M; Falzon, Louise et al. (2014) Visit-to-visit variability of blood pressure and cardiovascular disease and all-cause mortality: a systematic review and meta-analysis. Hypertension 64:965-82|
|Ye, Siqin; Wang, Y Claire; Shimbo, Daichi et al. (2014) Effect of change in systolic blood pressure between clinic visits on estimated 10-year cardiovascular disease risk. J Am Soc Hypertens 8:159-65|
|Shimbo, Daichi; Kent, Shia T; Diaz, Keith M et al. (2014) The use of ambulatory blood pressure monitoring among Medicare beneficiaries in 2007-2010. J Am Soc Hypertens 8:891-7|
|Peacock, J; Diaz, K M; Viera, A J et al. (2014) Unmasking masked hypertension: prevalence, clinical implications, diagnosis, correlates and future directions. J Hum Hypertens 28:521-8|
|Shimbo, Daichi; Wang, Lu; Lamonte, Michael J et al. (2014) The effect of hormone therapy on mean blood pressure and visit-to-visit blood pressure variability in postmenopausal women: results from the Women's Health Initiative randomized controlled trials. J Hypertens 32:2071-81; discussion 2081|
|James, Gary D; Alfarano, Alexandria S; van Berge-Landry, Helene M (2014) Differential circadian catecholamine and cortisol responses between healthy women with and without a parental history of hypertension. Am J Hum Biol 26:753-9|
|Diaz, Keith M; Booth 3rd, John N; Calhoun, David A et al. (2014) Healthy lifestyle factors and risk of cardiovascular events and mortality in treatment-resistant hypertension: the Reasons for Geographic and Racial Differences in Stroke study. Hypertension 64:465-71|
|Kent, Shia T; Shimbo, Daichi; Huang, Lei et al. (2014) Antihypertensive medication classes used among medicare beneficiaries initiating treatment in 2007-2010. PLoS One 9:e105888|
|Wasson, L T; Shaffer, J; Alcántara, C et al. (2014) The association of posttraumatic stress disorder and quality of life during the first year after acute coronary syndrome. Int J Cardiol 176:1042-3|
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