Psychosocial Factors and Cardiovascular Disease

拟议的研究建立在本报告所述期间进行的研究的令人兴奋的结果的基础上 资金。我们现有的计划项目（PPG; P01 HL 47540），现在开始其16* 年的资金， 侧重于心理社会因素在高血压（HT）和心血管疾病发展中的作用。 疾病（CVD）。它包括自1988年以来一直得到NHLBI持续支持的一系列工作 （最初是R 01），由哥伦比亚大学一个成熟的多学科研究小组进行 大学医学中心（CISC）和斯托尼布鲁克大学。我们发现了“隐性高血压” (MHT)一个人有正常的临床血压（BP），但平均白天走动的情况 血压高于高血压阈值虽然MHT不能通过传统的血压测量来诊断 标准，它是相关的，横截面，增加靶器官损伤。我们相信MHT是 巨大的临床，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 多达两千万美国人 所提出的PPG将调查MHT对a）未来血压（BP）升高的贡献 和lb）靶器官损伤的进展（项目1，前瞻性队列研究），2）靶器官损伤的进展（项目1，前瞻性队列研究）， 与MHT相关的心理生理机制（项目2，心理生理学实验室 反应性/恢复机制研究），以及3）以成本效益的方式改善高血压诊断的策略 方式（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 需要以具有成本效益的方式进行识别，以便进一步监测和/或治疗，如果我们要了解MHT的 机制和临床后遗症。我们将对当前MHT研究的参与者进行前瞻性随访， 有些人也被招募参加项目2。项目3的参与者将从 一般人口和初级保健诊所的卫生保健中心。它们将构成一个新的样本，即过采样 根据临床BP标准，患有高血压前期或未经治疗的1期高血压的患者。 拟议的P01将通过大幅增加我们的理解来解决NHLBI的目的和目标 MHT的临床后遗症和这种情况下的机制，并通过应用决定 科学的方法来开发一个大大改进的算法，用于诊断高血压， 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 对临床实践中用于常规测量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.