Psychosocial Pradictors of Masked Hypertension

这项研究的总体目标是调查“掩蔽性高血压诊断”，定义为平均清醒动态血压高于临床定义的临界点，临床血压低于临床临界点，以及“掩蔽性高血压效应”，定义为平均清醒动态血压高于临床血压的程度。初步研究表明，隐匿性高血压(MHT)的诊断相对常见，而且不是良性的，因为它似乎与靶器官损害增加以及心血管(CV)疾病的不良预后有关。根据定义，隐性高血压的诊断和影响不是通过常规的临床血压测量来诊断的，这增加了可能有大量患有隐性高血压的人从降压治疗中受益的可能性。虽然目前对隐匿性高血压知之甚少，但这项拟议的多方面研究将使我们能够确定(1)它在两个大型工作机构中的患病率，(2)MHT在多大程度上是由于血压测量的不稳定/不可靠，以及在多大程度上反映了一种稳定的状况，(3)预测(或可能导致)隐匿性高血压的行为、社会、心理和情景因素，以及(4)其与靶器官损害的关系。该项目将对随机抽取的1000名员工进行研究，其中500人来自两个大型组织。参与者将接受他们的诊所BP 评估3次，24小时佩戴动态血压监测仪和活动记录仪(体力活动水平)，并通过电子日记完成生态瞬时评估。员工还将完成一份心理社会调查问卷，并接受全面的非侵入性简历诊断评估。该问卷将评估个体及其环境的特征，这些特征可能导致门诊和动态血压的差异。CV评估将评估几个靶器官损害的早期标志物，以及传统的CV风险因素。在某种程度上，这项研究增加了我们对临床血压和动态血压之间的差异的理解，它将有助于解释为什么动态血压是更好的预后指标。我们预计，这也将有助于更好地理解BP的短暂上升可能导致长期的静息BP上升的过程。

The overall goal of this study is to investigate the "masked hypertension diagnosis", defined by a mean awake ambulatory pressure above a clinically-defined cutpoint and a clinic blood pressure below a clinical cutpoint, and the "masked hypertension effect", defined by the extent to which mean awake ambulatory pressure is higher than clinic blood pressure. Preliminary research suggests that a masked hypertension (MHT) diagnosis is relatively common and is not benign, as it appears to be associated with increased target organ damage as well as an adverse prognosis for cardiovascular (CV) disease. By definition, the masked hypertension diagnosis and the effect are not diagnosed by conventional clinic blood pressure measurement, which raises the possibility that there may be a large number of persons with masked hypertension who would benefit from antihypertensive treatment. While little is currently known about masked hypertension, this proposed multi-faceted study will enable us to determine (1) its prevalence in two large work organizations, (2) how much of MHT is due simply to the instability/unreliability of the blood pressure measures and how much reflects a stable condition, (3) behavioral, social, psychological, and situational factors that predict (and perhaps cause) masked hypertension, and (4) its association with target organ damage. This project will study 1000 randomly selected employees, 500 from each of two large organizations. Participants will have their clinic BP assessed on 3 occasions, wear an ambulatory BP monitor and actigraph (level of physical activity) for 24 hours, and complete ecologically momentary assessments by electronic diary. The employees will also complete a psychosocial questionnaire, and receive a comprehensive non-invasive CV diagnostic evaluation. The questionnaire will assess characteristics of the individual and his/her environment that may contribute to differences between clinic and ambulatory BP. The CV evaluation will assess several early markers of target organ damage, as well as traditional CV risk factors. To the extent that this study increases our understanding of the differences between clinic and ambulatory BP, it will help to explain why the latter is a better indicator of prognosis. We anticipate that it will also contribute to a better understanding of the process by which transient increases in BP can lead, in the long run, to permanent increases in resting BP.