Psychosocial Factors and Cardiovascular Disease

拟议的研究是基于本期间进行的研究得出的令人振奋的结果。 资金的问题。我们现有的计划项目(PPG；P01 HL47540)，现在开始其16*年的资助， 重点关注心理社会因素在高血压和心血管疾病发展中的作用 疾病(CVD)。它由一系列工作组成，自1988年以来一直得到NHLBI的支持 (最初是R01)，由哥伦比亚大学一个久负盛名的多学科调查小组进行 大学医学中心(CUMC)和石溪大学。我们已经确认了“蒙面高血压” (MHT)临床血压正常但日间平均活动的情况 血压高于高血压阈值。虽然通过常规的血压测量不能诊断MHT 根据标准，它与靶器官损伤的增加有关。我们相信MHT是 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，出现在 多达2000万美国人。 拟议的PPG将调查MHT对未来血压(BP)升高的贡献。 和lb)靶器官损害的进展(项目1，前瞻性队列研究)，2) MHT的心理生理学机制(S)(项目2，心理生理学实验室 反应性/恢复机制研究)，以及3)在具有成本效益的情况下提高高血压诊断的策略 方式(项目3，决策科学研究)。如果那些患有MHT的人，这个研究计划是至关重要的 是否以符合成本效益的方式确定用于进一步监测和/或治疗，以及如果我们要了解MHT的 机制和临床后遗症。我们目前MHT研究的参与者将被前瞻性地跟踪， 一些人也被招募参加项目2。项目3的参与者将从 普通人群和社区卫生服务中心的初级保健诊所。它们将构成一个新的样本，即过度抽样 根据临床血压标准，高血压前期或未治疗的1期高血压患者。 建议的P01将通过大幅提高我们的理解来解决NHLBI的目的和目标 MHT的临床后遗症和这种情况背后的机制，并通过应用一项决定 用科学的方法开发一种实质性改进的高血压诊断算法和 确定哪些人最有可能从治疗中受益。我们相信我们的发现很可能会有 对临床上常规测量血压的方法产生了重大影响。

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.