RACE, SOCIOECONOMIC STATUS, AND DIURNAL BLOOD PRESSURE RHYTHMS

这项研究旨在调查我们观察到的昼夜节律 两组黑人高血压患者血压节律不同 在纽约的两个医疗中心接受共同方案研究的患者 纽约市(纽约医院-康奈尔和哈莱姆医院)，分开 地理上只差几英里，但服务方式截然不同 人口。哈莱姆高血压病患者夜间失血减少 压力(‘非浸泡’模式)。血压模式并没有 在两组相应的血压正常者中不同。哈莱姆区高血压病 社会经济地位低于其他3组。少校 这项研究的目的是检验这样一个假设，即 高血压是心理社会因素的结果，包括 社会经济地位、职业压力和家庭压力，通过 (A)白天对血压的影响，和/或(B)对睡眠和血压的影响 在夜里。600正常血压和高血压黑白 研究对象将在这两个机构使用共同的协议进行研究。 这将包括24小时的血压和活动记录，分开 (昼夜)24小时尿液收集皮质醇、儿茶酚胺、 等，以及家庭多导睡眠图。调查问卷将评估心理社会 和人口统计因素，以及靶器官损害将通过 超声心动图、数字化心电图仪、踝臂指数和 微量白蛋白尿。邻里环境可能对 血压模式也将被评估。有人建议， 在黑色高血压患者中常见的非浸泡模式可能 对他们的预后有不利影响，我们会将血压 心脏和心脏靶器官损害的不同衡量标准的模式 肾脏。

This study is designed to investigate our observation that the diurnal rhythm of blood pressure is different in two groups of black hypertensive patients studied under a common protocol at two medical centers in New York City (New York Hospital-Cornell and Harlem Hospital), separated geographically by only a few miles, but serving very different populations. Harlem hypertensive had a diminished nocturnal fall of blood pressure (' a 'non-dipping' pattern). The blood pressure pattern did not differ in two corresponding groups of normotensives. Harlem hypertensives had lower socioeconomic status than the other 3 groups. The major objective of the study is to test the hypothesis that the difference seen in the hypertensives is the result of psychosocial factors, including socioeconomic status, occupational stress, and domestic stress, acting via (a) effects on BP during the day, and/or (b) effects on sleep and BP during the night. 600 normotensive and hypertensive black and white subjects will be studied at the two institutions with a common protocol. This will include a 24 hour blood pressure and activity recording, split (day and night) 24 hour urine collection for cortisol, catecholamines, etc., and home polysomnography. Questionnaires will evaluate psychosocial and demographic factors, and target organ damage will be assessed by echocardiography, digitized electrocardiography, ankle arm index, and micro-albuminuria. The possible effects of neighborhood environments on blood pressure patterns will also be evaluated. It has been suggested that the non-dipping pattern commonly seen in black hypertensive patens may adversely affect their prognosis, and we will related the blood pressure patterns to the different measures of target organ damage in the heart and kidneys.