Social, Genetic Determinants of Blood Pressure in Underserved African Americans

服务不足的非洲裔美国人血压的社会、遗传决定因素

• 批准号: 8202278
• 负责人: Sandra Marie Coulon
• 金额: $ 3.48万
• 依托单位: UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-16 至 2013-10-15
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8202278
• 关键词: Adrenal Glands; Adult; Affect; African; African American; Age; Biological; Biological Assay; Blood Pressure; Cardiovascular Diseases; Cause of Death; Censuses; Chronic Disease; Clinical; Clinical Trials; Communities; Complex; Crime; DNA; Data; Development; Direct Costs; Disease; Economic Burden; Elderly; Environmental Risk Factor; Equation; Ethnic group; Etiology; European; Experimental Models; Facilities and Administrative Costs; Funding; Genes; Genetic; Genetic Determinism; Genetic Polymorphism; Genomics; Glucocorticoid Receptor; Glucocorticoids; Health; Hormones; Hydrocortisone; Hypertension; Hypothalamic structure; Individual; Investigation; Laboratories; Life Style; Link; Low income; Measurement; Measures; Mediating; Medical Economics; Minority; Modeling; Neurosecretory Systems; Outcome; Participant; Pharmaceutical Preparations; Physiological; Pituitary Gland; Polymerase Chain Reaction; Population; Population Study; Prevalence; Prevention; Prevention approach; Prevention program; Prevention strategy; Public Policy; Questionnaires; Receptor Gene; Research; Risk; Risk Factors; Saliva; Salivary; Sampling; Screening procedure; Single Nucleotide Polymorphism; Social status; Social support; Socioeconomic Factors; Socioeconomic Status; Specific qualifier value; Statistical Models; Stress; Swab; System; Testing; United States; United States National Institutes of Health; biological adaptation to stress; biopsychosocial; design; environmental stressor; experience; gene environment interaction; gene interaction; health disparity; hypothalamic-pituitary-adrenal axis; innovation; insight; mortality; prevent; psychosocial; receptor function; response; selective prevention; sex; social; theories

DESCRIPTION (provided by applicant): High blood pressure (BP) is present in up to 78% of older adults in the United States, is more prevalent in African Americans than other ethnic groups, and is a leading cause of cardiovascular disease mortality. Social- environmental stress and social support factors, such as individual socioeconomic status (SES), have been linked to high BP, as have related physiological mechanisms such as hypothalamic-pituitary-adrenal (HPA) secretion of glucocorticoid stress hormones (e.g. cortisol), and genetic factors such as polymorphisms in glucocorticoid receptor (GR) genes. However, few studies have integrated these factors in African Americans, and social-environmental factors have often been measured at the individual- but not at the community-level, giving little insight into community factors (e.g. community SES) relevant to population-level efforts to understand BP regulatory mechanisms and health disparities. Investigating how these factors interact to influence BP outcomes may afford a better understanding of BP etiology and contribute to successful prevention efforts. Additionally, ecological, psychosocial, and biological theories of health may guide such an integrated investigation. Thus, the aim of the proposed study is to examine how community-level social- environmental factors interact with GR polymorphisms to predict cortisol and high BP, and whether cortisol mediates the association of social-environmental factors with BP as an underlying physiologic mechanism, as has been well established in clinical and experimental models. Data for each variable will be collected within an existing sample of older adult African Americans (N=434; Mage=51.2 years) nested within three communities as part of the on-going NIH-funded PATH trial. The PI of the trial, Dr. Dawn Wilson, is the primary sponsor of this application. Participants will attend health screenings during which data for target variables will be collected. Social-environmental variables will include census-derived community-level SES, community crime rates, and community connectedness measured via questionnaire. Saliva samples will allow measurement of morning and afternoon cortisol as a marker of basal HPA functioning and stress. Genomic DNA for three single nucleotide polymorphisms (SNPs) previously linked to social-environmental and physiologic mechanisms of high BP (Bcl1, rs 41423247; FKBP5, rs1360780; 92, rs6198) will be extracted from buccal swab samples and assayed via polymerase chain reaction, under the guidance of Dr. Matthew Kostek, a co-sponsor of this application. Structural equation modeling and regression will be applied to test stated study aims and hypotheses, with relevant covariates such as BP medication status, age, and sex included in statistical models. Potential clustering by community will be controlled by examining intra-class correlation coefficients. Thus, through the integrated study of social-environmental, physiologic, and genetic factors, this investigation will contribute to a comprehensive conceptualization of high BP and disparity in underserved African American populations, and has the potential to inform innovative prevention approaches and public policy. PUBLIC HEALTH RELEVANCE: The proposed study will expand our understanding of social-environmental, physiologic, and genetic effects on high blood pressure (BP) in African Americans. This project will ultimately inform prevention programs in reducing high BP, chronic disease, and health disparities experienced by African Americans.

描述(申请人提供)：高血压(BP)在美国高达78%的老年人中存在，在非裔美国人中比其他种族更普遍，是心血管疾病死亡的主要原因。社会环境压力和社会支持因素，如个人的社会经济地位(SES)，以及相关的生理机制，如下丘脑-垂体-肾上腺(HPA)糖皮质激素(如皮质醇)的分泌，以及遗传因素，如糖皮质激素受体(GR)基因的多态性，都与高血压有关。然而，很少有研究将这些因素整合到非裔美国人中，而且社会环境因素通常是在个人层面上衡量的，而不是在社区层面上衡量的，几乎没有深入了解与人口层面相关的社区因素(例如社区社会经济因素)，以了解BP调节机制和健康差异。研究这些因素如何相互作用影响BP的结局可能有助于更好地了解BP的病因，并有助于成功的预防工作。此外，生态学、心理学和生物学的健康理论可能会指导这样一项综合调查。因此，这项拟议研究的目的是研究社区水平的社会环境因素如何与GR基因多态性相互作用来预测皮质醇和高血压，以及皮质醇是否像临床和实验模型中已经确立的那样，作为潜在的生理机制调节社会环境因素与血压的关联。作为正在进行的NIH资助的PATH试验的一部分，每个变量的数据都将在三个社区内嵌套的现有老年非裔美国人样本(N=434；MAGE=51.2岁)中收集。这项试验的PI道恩·威尔逊博士是这项申请的主要赞助商。参与者将参加健康筛查，在此期间将收集目标变量的数据。社会环境变量将包括人口普查得出的社区层面的社会经济状况、社区犯罪率和通过问卷测量的社区连接性。唾液样本将允许测量上午和下午的皮质醇，作为基础HPA功能和压力的标志。在本申请的共同发起人之一马修·科斯特克博士的指导下，将从口腔拭子样本中提取三个先前与高血压的社会-环境和生理机制相关联的单核苷酸多态(SNPs)(bcl1，rs41423247；FKBP5，rs1360780；92，rs6198)的基因组DNA并通过聚合酶链式反应进行分析。结构方程建模和回归将用于检验所陈述的研究目标和假设，相关的协变量，如BP的用药状况、年龄和性别将包括在统计模型中。将通过检查类内相关系数来控制按社区进行的潜在聚类。因此，通过对社会-环境、生理和遗传因素的综合研究，这项调查将有助于全面概念化缺乏服务的非裔美国人人群中的高血压和差异，并有可能为创新的预防方法和公共政策提供信息。 公共卫生相关性：拟议的研究将扩大我们对非裔美国人高血压(BP)的社会环境、生理和遗传影响的理解。该项目最终将为预防计划提供信息，以减少非裔美国人经历的高血压、慢性病和健康差距。