Evaluating novel approaches for estimating awake and sleep blood pressure

评估估计清醒和睡眠血压的新方法

• 批准号: 10026029
• 负责人: Paul Muntner
• 金额: $ 4.88万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-15 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10026029
• 关键词: Adult; African American; Agreement; Alabama; Albumins; Ambulatory Blood Pressure Monitoring; Antihypertensive Agents; Anxiety; Blood Pressure; Canada; Cardiovascular Diseases; Clinic; Contusions; Creatinine; Data; Development; Devices; Diagnosis; Enrollment; Environment; Fostering; Funding; Goals; Health Personnel; Health behavior; Home Blood Pressure Monitoring; Home environment; Hour; Hypertension; Intervention; Intervention Trial; Left Ventricular Mass; Measurement; Measures; Mercury; Methods; Monitor; New York; Office Visits; Organ; Outcome; Pain; Parents; Participant; Patients; Persons; Pharmaceutical Preparations; Positioning Attribute; Prevalence; Procedures; Protocols documentation; Psychosocial Assessment and Care; Publications; Race; Reference Standards; Research; Research Personnel; Risk; Role; Sleep; Sphygmomanometers; Testing; Time; Training; Universities; Visit; anxiety states; awake; blood pressure intervention; cardiovascular risk factor; diagnosis standard; health disparity; indexing; masked hypertension; monitoring device; novel; novel strategies; psychosocial; recruit; screening; skills; urinary

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.

在美国，高血压是通过医疗保健提供者在办公室测量血压 (BP) 来诊断的 或技术人员，这种方法称为值班办公室 BP。然而，这种方法提供的估计很差 一个人的血压。动态血压监测 (ABPM) 每 15 至 30 分钟自动测量一次血压 通常 24 小时不在办公室环境中，包括在人醒着和睡着时。虽然 ABPM被认为是诊断高血压的参考标准，但大多数诊所都没有 在美国，即使有这种药物，许多患者也无法耐受。这些问题凸显了新的需求 高血压的诊断方法。加拿大研究表明，在办公室使用血压计测量血压 无需观察员在场的自动示波装置，这种方法称为无人值守办公室 血压可能比就诊血压更接近动态血压监测的清醒血压。这些发现提出了这样的可能性： 与办公环境相关的因素（例如患者焦虑）可能会导致两者之间的差异 参与和无人参与的血压测量。拟议研究的主要目标是确定角色 在办公室测量血压时的状态焦虑或特定时刻的焦虑 睡眠期间。拟议的研究将： 1）确定状态焦虑与 无人值守与有人值守测量的诊室血压之间的差异，2) 确定两者之间的关联 睡前状态焦虑和睡眠血压，以及 3) 确定办公室状态焦虑之间的关联 以及睡前和左心室质量指数。鉴于睡眠血压水平较高，且风险增加 与非裔美国人相比，心血管靶器官损伤和心血管疾病 对于白人，我们将研究不同种族的状态焦虑与结果之间的关联差异。通过 拟议的研究者研究补充材料候选人 Shakia Hardy 博士有一个独特的机会 使用从母研究中收集的数据来检验她的假设，评估新方法 估计清醒和睡眠血压，R01 HL139716，PI Paul Muntner，在University of 阿拉巴马州伯明翰大学和哥伦比亚大学有既定的协议和持续的参与者 注册。为了促进这项研究并促进哈代博士走向独立之路，她将获得 血压测量和解释以及亚临床心血管的额外培训 疾病、心血管疾病的心理社会决定因素、健康差异的决定因素，以及 专业发展。从完成培训和研究目标中获得的技能和成果 该提案将产生科学演示和出版物以及成功竞争的初步数据 K01 资助，使哈代博士能够为社会心理研究做出重要贡献 高血压和心血管疾病的决定因素。