PTSD, Sleep, and Risk for Incident Hypertension

 描述（由申请人提供）：本研究的目的是测试创伤后应激障碍（PTSD）与昼夜动态血压（ABP）的前瞻性关系，从而与高血压和心血管疾病（CVD）的风险之间的关系。创伤后应激障碍是创伤的后果，部分特征是过度觉醒，情绪失调和睡眠不良，与传统的风险因素无关，CVD的风险增加了50%。大型队列研究报告高血压的患病率更高，包括我们的n= 200，000试点分析，这也表明PTSD治疗可能会降低这种风险。关键问题涉及高血压风险的早期检测，以及PTSD治疗是否可以降低这种风险。动态血压（ABP）是一个更好的预测心血管疾病的风险比临床血压140/90毫米汞柱的诊断高血压。ABP监测结合电子日记的生态瞬时评估（EMA）创建了一个强大的工具，使用这个工具，我们发现愤怒和焦虑的瞬时评级与血压（BP）的瞬时升高高度相关。当与夜间活动记录相结合时，另一个强大的工具被创建，从而可以确定睡眠对ABP的影响。这些工具结合在一起可能对测试PTSD与ABP的前瞻性关系以及CVD风险特别有用，因为PTSD的特征之一是对日常事件的情绪反应性增强，以及睡眠中断。利用我们最近资助的女性退伍军人队列研究-第2波和我们的国家创伤后应激障碍中心的资源，我们建议研究300名最近的退伍军人，有和没有创伤后应激障碍诊断（N=150每个）2次，间隔2年。我们假设，1）基线时有PTSD的人与无PTSD的人相比，2年内白天和夜间ABP的增加更大，2a）对瞬时负面情绪和PTSD症状的ABP反应更大，并且活动记录仪评估的睡眠更差; 2b）负面情绪/PTSD症状和睡眠不良将部分介导PTSD与白天和夜间ABP的预期关联; 3）从基线到随访的PTSD改善（例如，由于PTSD治疗或自然轨迹），将与ABP在2年内的降低或较小的增加相关。完成基线评估后，我们将评估PTSD状态和症状严重程度与以下因素的横截面关系：1）白天和夜间ABP，2）EMA报告的PTSD症状比例，3）EMA报告的负面影响平均水平，4）睡眠不良。我们还将分析睡眠不佳-持续时间短，效率-对1）瞬间负面情绪和PTSD症状的影响，以及2）瞬间负面情绪和PTSD症状与ABP的关系。意义拟议的研究将指出风险缓解临床试验的方向，无论他们是否根据阈值PTSD症状测试ABPM的靶向使用，积极的PTSD治疗，和/或早期干预与药物，行为，或联合策略治疗PTSD患者白天或夜间ABP升高。

 DESCRIPTION (provided by applicant): The purpose of this study is to test the prospective relationship of post-traumatic stress disorder (PTSD) to day and night time ambulatory blood pressure (ABP) and thus, risk for hypertension and incident cardiovascular disease (CVD). PTSD occurs consequent to trauma and is characterized in part by hyperarousal, emotional dysregulation, and poor sleep, with a 50% greater risk for CVD, independent of traditional risk factors. Large cohort studies report greater prevalence of hypertension, including our n=200,000 pilot analyses, which also show that PTSD treatment may attenuate this risk. Critical questions concern early detection of hypertension risk, and whether PTSD treatment reduces this risk. Ambulatory blood pressure (ABP) is a better predictor of CVD risk than is the clinic blood pressure of 140/90mmHg on which a diagnosis of hypertension is made. ABP monitoring combined with ecological momentary assessment (EMA) by electronic diary creates a powerful tool, and using this we have found that momentary ratings of anger and anxiety are highly correlated with momentary elevations in blood pressure (BP). When combined with night time actigraphy, another powerful tool is created whereby the effects of sleep on ABP can be determined. These tools together may be particularly useful for testing the prospective relationship of PTSD to ABP and thus CVD risk, since among the hallmarks of PTSD are heightened emotional reactivity to daily events, and disrupted sleep. Leveraging the resources of our recently funded Women Veterans Cohort Study-Wave 2 and our National Center for PTSD, we propose to study 300 recent military veterans with and without a PTSD diagnosis (N=150 each) on 2 occasions, 2-years apart. We hypothesize that, 1) those with vs. without PTSD at baseline will show a greater 2-year increase in day and night time ABP, and 2a) will have a greater ABP response to both momentary negative emotion and PTSD symptoms, and poorer actigraphy-assessed sleep; 2b) negative emotions/PTSD symptoms and poor sleep will in part mediate the prospective association of PTSD to day and night time ABP; 3) improvement in PTSD from baseline to follow-up (e.g., due to PTSD treatment or natural trajectory), will be associated with a decrease or smaller increase in ABP over the 2 years. Upon completion of baseline assessments we will evaluate the cross-sectional relationships of PTSD status and symptom severity to: 1) day and night time ABP, 2) the proportion of EMA reports with PTSD symptoms endorsed 3) mean levels of EMA-reported negative affect, and 4) poor sleep. We will also analyze the effect of poor sleep - short duration, efficiency - on, 1) momentary negative emotions and PTSD symptoms, and 2) the relationship of momentary negative emotions and PTSD symptoms to ABP. Significance. The proposed study will point the way toward risk mitigation clinical trials, whether they test the targeted use of ABPM according to threshold PTSD symptoms, aggressive PTSD treatment, and/or early intervention with pharmaceutical, behavioral, or combined strategies for treating elevated day or night time ABP among individuals with PTSD.