PTSD, Sleep, and Risk for Incident Hypertension

 描述(申请人提供)：这项研究的目的是测试创伤后应激障碍(PTSD)与昼夜动态血压(ABP)的预期关系，从而测试高血压和心血管疾病(CVD)的风险。创伤后应激障碍是由创伤引起的，部分特征是过度觉醒、情绪失调和睡眠不佳，不考虑传统的危险因素，患心血管疾病的风险增加50%。大型队列研究报告了更高的高血压患病率，包括我们的n=200,000个试点分析，这也表明创伤后应激障碍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发现，以及创伤后应激障碍治疗是否降低了这种风险。动态血压(ABP)比诊断高血压的140/90毫米汞柱的临床血压更能预测心血管疾病的风险。ABP监测与电子日记的生态瞬时评估(EMA)相结合创造了一个强大的工具，利用这一工具，我们发现愤怒和焦虑的瞬时评级与瞬时血压升高高度相关。当与夜间活动相结合时，另一个强大的工具被创造出来，通过它可以确定睡眠对动脉血压的影响。这些工具结合在一起可能对测试创伤后应激障碍与动脉血压的潜在关系以及心血管疾病风险特别有用，因为创伤后应激障碍的特征之一是对日常事件的情绪反应增强，并扰乱睡眠。利用我们最近资助的女性退伍军人队列研究-浪潮2和我们的国家创伤后应激障碍中心的资源，我们建议对300名最近被诊断患有和不患有创伤后应激障碍(N=150)的退伍军人进行两次研究，时间间隔2年。我们假设，1)基线有创伤后应激障碍的患者与无创伤后应激障碍的患者相比，两年内白天和夜间的ABP上升幅度更大，2a)对短暂的负面情绪和创伤后应激障碍症状的反应更大，睡眠更差；2b)消极情绪/创伤后应激障碍症状和睡眠质量差将部分地调节创伤后应激障碍与白天和夜间的ABP的未来关联；3)从基线到随访(例如，由于创伤后应激障碍的治疗或自然轨迹)，创伤后应激障碍的改善将与两年内ABP的下降或较小幅度上升相关。在完成基线评估后，我们将评估创伤后应激障碍状态和症状严重程度的横断面关系：1)昼夜ABP，2)EMA报告中认可PTSD症状的比例，3)EMA报告的负面情绪的平均水平，以及4)睡眠不佳。我们还将分析睡眠质量差-持续时间短、效率高-1)瞬时负面情绪和创伤后应激障碍症状，以及2)瞬时负面情绪和创伤后应激障碍症状与ABP的关系。意义重大。这项拟议的研究将为降低风险的临床试验指明方向，无论它们是根据创伤后应激障碍的阈值症状测试ABPM的靶向使用，积极的创伤后应激障碍治疗，和/或药物、行为或综合策略的早期干预，以治疗患有创伤后应激障碍的个体白天或夜间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.