Evaluating novel approaches for estimating awake and sleep blood pressure

在美国，高血压的诊断是由医疗保健提供者在办公室测量血压(BP) 或技术人员，这种方法被称为值班办公室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到30分钟自动测量一次血压 在办公室之外，通常是24小时，包括一个人醒着和睡着的时候。虽然 ABPM被认为是诊断高血压的参考标准，大多数诊所都没有 在美国，如果可以的话，它不会被许多患者耐受。这些问题突显了新的 高血压的诊断方法。加拿大的研究表明，英国石油公司在办公室使用 无人值守的自动示波装置，一种称为无人值班的方法 BP，可能更接近于在ABPM唤醒BP，而不是参加办公室BP。这些发现增加了这样一种可能性 与办公室环境相关的因素，如患者焦虑，可能会导致 有人看管和无人看管的血压。拟议研究的主要目标是确定 状态焦虑，或在特定时刻的焦虑，在办公室测量血压和 在睡觉的时候。这项拟议的研究将：1)确定状态焦虑和 无人值守和有人值守的办公室血压之间的差异，2)确定 睡前状态焦虑和睡眠血压，以及3)决定办公室状态焦虑之间的联系 以及睡前和左心室重量指数。考虑到更高的睡眠血压水平和更高的风险 非裔美国人心血管靶器官损害和心血管疾病的比较 对于白人，我们将检查状态焦虑和种族结果之间的联系的差异。穿过 拟议的调查者研究补充候选人Shakia Hardy博士有一个独特的机会来 使用从父母研究中收集的数据来测试她的假设，评估新的方法 估计清醒和睡眠中的血压，R01 HL139716，Pi Paul Muntner，在华盛顿大学进行 阿拉巴马州伯明翰和哥伦比亚大学，有既定的协议和持续的参与者 招生。为了促进这项研究并促进哈迪博士的独立之路，她将获得 在测量和解释血压和亚临床心血管疾病方面的额外培训 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 职业发展。从完成培训和研究目标中获得的技能和结果 这项提议将导致科学报告和出版物，以及成功竞争的初步数据 K01资助，并独一无二地定位了Hardy博士在心理社会研究中的重要贡献 高血压和心血管疾病的决定因素。

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.