Incorporation of a Hypertension Working Group into the Jackson Heart Study

描述(申请人提供)：从童年开始，非裔美国人的血压水平就高于白人。在我们小组最近的一项分析中，45岁时没有高血压的非裔美国人有90%的终生高血压风险。此外，与接受降压药治疗的白人相比，接受降压药治疗的非裔美国人更不可能达到指南推荐的血压水平。在非裔美国人中，与高血压相关的医疗保健影响是深远的；高血压是中风、心力衰竭和 终末期肾病(ESRD)，在非裔美国人中比白人更常见的疾病。在本申请中，我们建议将高血压工作组合并到杰克逊心脏研究(JHS-HWG)中。建议进行四个专题调查：1.高血压事件的危险因素；2.24小时动态血压监测(ABPM)的血压表型；3.未控制的高血压，包括难治性高血压；以及4.用药依从性。由于非裔美国人高血压和血压控制的失调是复杂的，可能是多维的，我们建议建立一个多学科的调查团队，他们在高血压、健康差异、心理社会健康、流行病学、生物统计学和临床心脏病学方面具有互补的专业知识。JHS是一项理想的基于人群的研究，可以进一步加深我们对非裔美国人中BP问题的理解。JHS在2000-2004年间招募了5301名非裔美国人，并在每隔4年进行的三次研究访问中收集了药物使用和依从性、亚临床动脉粥样硬化措施、心理社会变量以及血和尿生物标记物的数据。积极跟踪参与者的临床结果(例如，冠心病、住院心力衰竭和中风)的发生情况。此外，ABPM是在1,076名JHS参与者的子样本中进行的基线ABPM，使这项研究成为美国ABPM最大的基于人群的研究之一。ABPM可用于估计血压变异性和昼夜血压，并诊断白大衣和面罩高血压，这是在非裔美国人中未被研究的新出现的心血管疾病风险因素。JHS-HWG的另一个主要目标将是为早期调查人员(ESIS)提供指导，特别强调代表性不足的研究人员。这将包括让Esis领导JHS写作小组和JHS辅助拨款申请，以帮助他们向独立过渡。被纳入本申请的教育机构是因为他们的研究潜力、对少数群体健康的兴趣以及申请中的主题领域。首席研究人员在指导方面有着良好的记录，他们也将得到咨询委员会和高级教师专家小组的支持，他们都在少数群体健康和高血压相关领域有很强的指导历史和研究效率。最后，我们计划向JHS提交辅助研究，使JHS-HWG在资助期过后能够自给自足。

DESCRIPTION (provided by applicant): Beginning in childhood, African Americans have higher blood pressure (BP) levels than whites. In a recent analysis by our group, African Americans without hypertension at 45 years of age had > 90% lifetime risk for developing incident hypertension. Further, African Americans treated with antihypertensive medications are less likely to achieve guideline recommended BP levels when compared to whites on antihypertensive medications. The health care implications associated with hypertension in African Americans are profound; hypertension is a strong risk factor for stroke, heart failure, and end-stage renal disease (ESRD), conditions that occur more frequently among African Americans than whites. In this application, we propose to incorporate a Hypertension Working Group into the Jackson Heart Study (JHS-HWG). Four thematic areas of investigation are proposed: 1. Risk factors for incident hypertension; 2. BP phenotypes using 24 hour ambulatory BP monitoring (ABPM); 3. Uncontrolled treated hypertension including treatment resistant hypertension; and 4. Medication adherence. As the dysregulations underlying hypertension and BP control in African American are complex and likely multi-dimensional, we propose a multi- disciplinary team of investigators with complementary expertise in hypertension, health disparities, psychosocial health, epidemiology, biostatistics, and clinical cardiology. The JHS is an ideal population-based study to further our understanding of BP issues in African Americans. JHS enrolled 5,301 African Americans in 2000-2004 and data were collected on medication use and adherence, sub-clinical atherosclerosis measures, psychosocial variables, and blood and urine biomarkers during three study visits at 4 year intervals. Participants are being actively followed for the occurrence of clinical outcomes (e.g., coronary heart disease, hospitalized heart failure, and stroke). Additionally, ABPM was conducted at baseline in a sub-sample of 1,076 JHS participants, making this one of the largest population-based studies with ABPM in the US. ABPM can be used to estimate BP variability and diurnal BP, and diagnose white coat and masked hypertension, emerging cardiovascular disease risk factors that are understudied in African Americans. Another primary objective of the JHS - HWG will be to provide mentorship to early stage investigators (ESIs), with a special emphasis on under-represented researchers. This will include having ESIs lead JHS writing groups and JHS ancillary grant applications, to aid in their transition towards independence. The ESIs included in this application were chosen for their research potential, interest in minority health and the thematic areas in the application The principal investigators, who have an excellent track record of mentorship, will also be supported by an Advisory Committee and expert panel of Senior Faculty Mentors, who all have a strong history of mentorship as well as research productivity in minority health and hypertension-related areas. Finally, we plan to submit ancillary studies to JHS that make the JHS-HWG self-sustaining beyond the funding period.