This Program Project proposal represents a continuation and further development of our existing Program Project. It comprises a body of work which has been supported continuously by the NHLBI since 1985, and is focused on the role of psychosocial factors in the development of hypertension and cardiovascular disease, by a well-established and multi- disciplinary group of investigators at Cornell University Medical College and neighboring institutions. The proposed four projects are all outgrowths of our previous and current work, and have several related themes. Project 1 (Race, SES, and Diurnal Blood Pressure Rhythms) is a continuation of a study of the prospective significance of ambulatory blood pressure (ABP), which is being performed at two sites- New York Hospital- Cornell and Harlem Hospital. The Sleep Heart Health Study is an add-on to this, and in the new study we will combine the techniques of both to undertake a comprehensive analysis of the psychological, social, and physiological factors which influence sleep patterns and the diurnal rhythm of blood pressure. We wish to explain why black patients from Harlem show a flatter diurnal rhythm than blacks from Cornell. Project 2 (Completion of the Work Site Blood Pressure Study) will be the conclusion of our study of the effects of job strain on blood pressure, in which we will perform sleep recording son 90 nurses enrolled in the study, and ABPM in 40 subjects who have retired or left New York. A major goal will be to conclude the analysis of data collected over 13 years in more than 400 subjects. Project 3 (Life style, SES, and AMBP in Employed Parents) will simultaneously monitor both members of a married couple, to study how men and women perceive occupational and domestic stressors, and how this affects their blood pressure. This study will be performed at several locations in and around New York city, using school parent-teacher associations as the basis of recruitment. Project 4 (White Coat Hypertension: Psychobehavioral Mechanisms) is another continuation of an existing theme, and will investigate the hypothesis that white coat hypertension is a learned response, occurring as a result of classical and cognitive conditioning, with the physician acting as the conditioned stimulus which initiates the blood pressure response. The 4 projects are supported by 4 cores.
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