In the US, hypertension is diagnosed by measuring blood pressure (BP) in the office by a healthcare provider or technician, an approach referred to as attended office BP. However, this approach provides a poor estimate of a person's BP. Ambulatory BP monitoring (ABPM) measures BP automatically every 15 to 30 minutes outside of the office setting typically for 24 hours including while a person is awake and asleep. Although ABPM is considered to be the reference standard for diagnosing hypertension, it is not available in most clinics in the US and, when available, it is not tolerated by many patients. These issues highlight the need for new approaches for diagnosing hypertension. Canadian studies suggest that BP measured in the office using an automatic oscillometric device without an observer being present, an approach referred to as unattended office BP, may be closer to awake BP on ABPM than attended office BP. These finding raise the possibility that factors associated with the office environment such as patient anxiety may contribute to differences between attended and unattended blood pressure. The main objective of the proposed research is to determine the role of state anxiety, or anxiety at a specific moment in time, in the measurement of blood pressure in the office and during sleep. The proposed research will: 1) Determine the association between state anxiety and the difference between office BP measured unattended versus attended, 2) Determine the association between state anxiety at bedtime and sleep BP, and 3) Determine the association between state anxiety in the office and at bedtime and left ventricular mass index. Given the higher levels of sleep BP and increased risk for cardiovascular target organ damage and cardiovascular disease among African Americans compared with whites, we will examine differences in the association between state anxiety and outcomes by race. Through the proposed Investigator Research Supplement the candidate, Dr. Shakia Hardy, has a unique opportunity to test her hypotheses using data being collected from the parent study, Evaluating novel approaches for estimating awake and sleep blood pressure, R01 HL139716, PI Paul Muntner, conducted at the University of Alabama at Birmingham and Columbia University with an established protocol and ongoing participant enrollment. To facilitate this research and foster Dr. Hardy?s path toward independence, she will gain additional training in the measurement and interpretation of blood pressure and subclinical cardiovascular disease, psychosocial determinants of cardiovascular disease, determinants of health disparities, and professional development. Skills and findings obtained from the completion of the training and research aims of this propose will result in scientific presentations and publications, preliminary data to successfully compete for K01 funding, and uniquely position the Dr. Hardy to make important contributions to the study of psychosocial determinants of hypertension and cardiovascular disease.
The proposed study will evaluate whether anxiety during the doctor?s office visit and at bedtime is associated with higher blood pressure measured by a person during an office visit and while asleep. Finding from this study may identify patients who would benefit from having their blood pressure measured unattended in the office and interventions to reduce their anxiety and lower their sleep blood pressure.
| Muntner, Paul; Shimbo, Daichi (2018) Out-of-Clinic Blood Pressure Thresholds for Diagnosing and Managing Hypertension, Filling an Important Evidence Gap. Hypertension 72:1266-1268 |
