Psychosocial Factors and Cardiovascular Disease

拟议的研究建立在当前资助期间进行的研究的令人兴奋的发现的基础上。我们现有的计划项目（PPG; P01 HL 47540），现在开始其16年的资助，重点是心理社会因素在高血压（HT）和心血管疾病（CVD）发展中的作用。它包括自1988年以来一直得到NHLBI（最初为R 01）持续支持的一系列工作，由哥伦比亚大学医学中心（CDC）和斯托尼布鲁克大学的一个完善的多学科研究小组进行。我们已经确定了“隐性高血压”（MHT），即一个人的临床血压（BP）正常，但平均日间动态血压高于高血压阈值的情况。虽然MHT不能通过传统的BP测量标准进行诊断，但它在横截面上与靶器官损伤增加相关。我们认为MHT具有重要的临床、病因学和公共卫生意义，因为它可能是一种高度流行的疾病，存在于多达2000万美国人中。所提出的PPG将研究MHT对la）未来血压（BP）升高和lb）靶器官损伤进展的贡献（项目1，前瞻性队列研究），2）与MHT相关的心理生理机制（项目2，心理生理学实验室反应/恢复机制研究），和3）以成本效益方式改善高血压诊断的策略（项目3，决策科学研究）。这项研究计划是至关重要的，如果那些与MHT是具有成本效益的确定进一步监测和/或治疗，如果我们要了解MHT的机制和临床后遗症。我们将前瞻性地跟踪我们当前MHT研究的参与者，其中一些参与者也将被招募参加项目2。项目3的参与者将从普通人群和社区卫生组织的初级保健诊所招募。他们将构成一个新的样本，根据临床BP标准对高血压前期或未经治疗的1期高血压患者进行过采样。拟议的P01将通过大幅提高我们对MHT临床后遗症和这种疾病背后机制的了解，并应用决策科学方法开发大幅改进的诊断高血压和识别高血压的算法，来实现NHLBI的目标和目的。最有可能从治疗中受益。我们认为，我们的研究结果可能会对临床实践中常规测量BP的方法产生重大影响。

The proposed research builds on exciting findings from the research conducted during the current period of funding. Our existing Program Project (PPG; P01 HL47540), now beginning its 16* year of funding, focuses on the role of psychosocial factors in the development of hypertension (HT) and cardiovascular disease (CVD). It comprises a body of work that has been supported continuously by NHLBI since 1988 (originally an R01), conducted by a well-established, multidisciplinary group of investigators at the Columbia University Medical Center (CUMC) and Stony Brook University. We have identified "Masked Hypertension," (MHT) the condition in which one has normal clinic blood pressure (BP) but an average daytime ambulatory BP above the threshold for hypertension. Although MHT is not diagnosed by conventional BP measurement criteria, it is associated, cross-sectionally, with increased target organ damage. We believe MHT to be of great clinical, etiological, and public health significance, as it is likely a highly prevalent condition, present in as many as 20 million Americans. The proposed PPG will investigate the contribution of MHT to la) future increases in blood pressure (BP) and lb) progression of target organ damage (Project 1, a prospective cohort study), 2) the psychophysiological mechanism(s) associated with MHT (Project 2, a psychophysiology laboratory reactivity/recovery mechanistic study), and 3) strategies to improve the diagnosis of hypertension in a costeffective manner (Project 3, a decision science study). This research program is crucial if those with MHT are to be cost-effectively identified for further monitoring and/or treatment, and if we are to understand MHT's mechanisms and clinical sequelae. Participants in our current MHT Study will be followed prospectively, with some being recruited to also participate in Project 2. Participants for Project 3 will be recruited from the general population and the primary care clinics of CUMC. They will constitute a new sample, over-sampling those with pre-hypertension or untreated Stage 1 hypertension by clinical BP criteria. This proposed P01 will address the NHLBI aims and goals by substantially increasing our understanding of the clinical sequelae of MHT and the mechanisms underlying this condition, and by applying a decision science approach to the development of a substantially improved algorithm for diagnosing hypertension and identifying those who are most likely to benefit from treatment. We believe that our findings are likely to have a major impact on the methods used to measure BP routinely in clinical practice.