In the US, African Americans have a higher risk for hypertension, end-organ damage from hypertension, and hypertension-related cardiovascular disease (CVD) and renal disease outcomes than other race groups. In 2015, the National Heart Lung and Blood Institute (NHLBI) assembled an ad-hoc working group to identify research needs to improve hypertension treatment and blood pressure (BP) control in African Americans. In this application, we propose the renewal of the Jackson Heart Study Hypertension Working Group (JHS? HWG), which will address several high priority needs identified by the NHLBI working group, and provide mentorship to early stage investigators (ESIs) in hypertension research. Given its large sample size and extensive phenotyping, the JHS is the ideal setting for addressing several knowledge gaps in hypertension among African Americans. Between 2000 and 2004, 5,306 African Americans were enrolled in the JHS and completed a baseline study visit that included clinic BP measurements, a pill bottle review, and questionnaires on medication adherence and psychosocial factors. Ambulatory blood pressure (BP) monitoring (ABPM) was conducted at baseline in 1,046 JHS participants, making the JHS one of the largest studies with ABPM in the US. Study visits have been conducted 4 and 8 years following baseline at which time hypertension onset and organ damage were assessed. Participants have been followed over 10 years for CVD events. In the initial three years of funding, JHS-HWG ESIs have published 16 manuscripts and have 11 manuscripts undergoing peer review (26 with ESIs as the first author). JHS-HWG ESIs have been successful in obtaining grant funding including one R01, five K awards, three diversity supplements and one pre-doctoral F31 grant award. Seven of these ESIs are under-represented minorities. Further, JHS-HWG members have developed expert knowledge of the JHS data set that will result in even higher productivity during the renewal period. For the 4- year renewal period, we propose conducting in-depth studies in four new core thematic areas: (1) Remaining free of hypertension across the lifespan, and among those with hypertension, remaining free of organ damage and CVD events; (2) Using predicted CVD risk to guide antihypertensive medication initiation and titration; (3) Maintaining persistent BP control over 8 years of follow-up; and (4) Diurnal BP patterns on ABPM. New activities for ESIs include training in advanced statistical methods, analysis of administrative claims, conduct of health policy evaluations, and leading pilot studies, which will begin the translation of findings from the JHS into improving outcomes. The JHS-HWG will be led by principal investigators, who have a strong collaboration history, and an established track record of publishing high impact hypertension research and mentoring ESIs. The JHS-HWG also has an Advisory Committee, comprised of internationally recognized hypertension experts, and a panel of Senior Faculty Mentors available to the ESIs. Ultimately, through the JHS-HWG, we aim to improve the health of African Americans, and invigorate the next generation of hypertension researchers.
Significance: The Jackson Heart Study Hypertension Working Group (JHS-HWG) has established an infrastructure to conduct high impact hypertension research. Over the next four years, the JHS?HWG will conduct research to identify approaches for reducing the burden of hypertension and hypertension-related cardiovascular disease outcomes in African Americans. Also, the JHS-HWG will continue to provide a foundation for early stage investigators to become leaders in the field of hypertension research.
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