This is an application for a 5 year renewal of a series of interdisciplinary studies designed to investigate ways in which behavioral factors can influence the diagnosis and development of hypertension, which will be evaluated using ambulatory blood pressure (BP) monitoring. It is hypothesized that such factors are important in at least three ways: first, by causing transient elevations of clinic BP in subjects who are normotensive at other times (defined as white coat hypertension), they may result in mis- classification of such individuals as being truly hypertensive; second, they may raise BP during everyday stress; and third, they may perhaps contribute to the development of sustained hypertension. A major focus of this work is on occupational stress. It is hypothesized (from the Job Strain Model) that BP will be higher at work in individuals in high-strain jobs, characterized by a high workload and low decision latitude. Five studies are proposed. Study 1 will follow-up 1,500 patients who will have had ambulatory BPs recorded over the last 8 years, to determine whether ambulatory BP improves the prediction of morbid events relative to clinic BP. Study 2 will evaluate factors contributing to white coat hypertension, and whether it can be treated behaviorally. Study 3 will compare the reactivity to beta- adrenergic stimulation and to behavioral tasks in normal subjects and patients with hypertension or depression. Study 4 will test the Job Strain Model in the laboratory, by investigating the inter- active effects on BP of varying levels of workload (task difficulty) and decision latitude (degree of personal control) during a challenging behavioral task. Generalization of this measure of reactivity will be assessed by comparison with ambulatory BP recordings. Study 5 will be a cohort study of 400 subjects followed from our existing case control study located at different worksites in New York City, which is investigating the influence of psychosocial factors on BP. A major goal of this study is to determine whether individuals in high-strain jobs show greater elevations of BP over 5 years than those in low-strain jobs.
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