PSYCHOSOCIAL FACTORS AND CARDIOVASCULAR DISEASE

本计划项目建议书是我们现有计划项目(PO1 HL47540)的延续，现已进入第10个年头。自1985年以来，由NHLBI支持，它包括一系列工作，重点是心理社会因素在高血压和心血管疾病发展中的作用，由西奈山医学院和邻近机构的一个成熟的多学科研究小组领导。拟议的项目是我们以前和现在工作的结果，集中在一系列关于持续血压升高的原因和后果的相互关联的主题上。项目1(动态BP和CV事件的国际跟踪)扩展了我们对 动态血压监测在临床和科研中的应用。我们的目标是完成过去23年来在我们诊所看到的患者的动态血压和后续心血管事件的全面数据库的数据收集。这些数据将与来自其他国家的实验室的类似预期数据库合并在一起，为研究动态血压和心血管事件之间的剂量-反应关系以及调查不同文化之间的相似/差异提供强大的力量。项目2(掩蔽性高血压-危险因素和后果)侧重于动态血压和临床血压之间的差异，以及那些在自然环境中动态监测时临床血压正常但高血压的人。这些人(估计占人口的10%-20%)是一个重要的 研究人类高血压的模型，因为这些人可能处于终末器官损害的高风险(由于他们的动态血压升高，不太可能得到治疗)。本研究将探讨ABP/临床血压差值的重复性，与这种差值相关的心理社会因素，以及这种差值是否与左心室结构和功能有关。项目3(愤怒的持之以恒的认知对动态血压的影响)是我们研究长期血压升高的认知和心理基础的扩展。这项研究将利用愤怒认知的现场操作，并在实验室检验其对血压恢复的影响 在战场上也是如此。

This Program Project proposal represents a continuation of our existing Program Project (PO1 HL47540), which is now entering its 10th year. Supported by NHLBI since 1985, it comprises a body of work that focuses on the role of psychosocial factors in the development of hypertension and cardiovascular disease, led by a well-established, multidisciplinary group of investigators at Mount Sinai School of Medicine and neighboring institutions. The proposed projects are an outgrowth of our previous and current work, and focus on a set of inter-related themes concerning the causes and consequences of sustained blood pressure elevation. Project 1 (International Follow-Up of Ambulatory BP and CV Events) extends our focus on the utility of ambulatory blood pressure monitoring in clinical and research applications. The goal is to complete the data collection for a comprehensive data base of ambulatory blood pressures and follow-up cardiovascular events in patients seen in our clinic over the past 23 years. These data will be pooled with similar prospective data bases from laboratories from other countries, providing substantial power to study the dose-response relationship between ambulatory blood pressure and cardiovascular events and investigate similarities/differences across cultures. Project 2 (Masked Hypertension - Risk Factors and Consequences) focuses on the difference between ambulatory and clinic blood pressures and those persons who exhibit normal clinic blood pressure but hypertensive blood pressure during ambulatory monitoring in the natural environment. These persons (estimated at 10%-20% of the population) represent an important model for the study of human hypertension, as these persons may be at elevated risk for end organ damage (due to their elevated ambulatory blood pressure and are unlikely to be treated. This study will investigate the reproducibility of the ABP/clinic BP difference, the psychosocial factors that are associated with this difference, and whether this difference is associated with left ventricular structure and function. Project 3 (Effects of Angry Perseverative Cognition on Ambulatory BP) is an extension of our research examining the cognitive and psychological underpinnings of prolonged blood pressure elevation. This study will utilize a field manipulation of angry cognition, and examine the effects on blood pressure recovery in the laboratory and in the field.