Psychosocial Factors and Cardiovascular Disease

拟议的研究建立在本供资期间进行的研究中令人振奋的结果的基础上。我们现有的计划项目(PPG；P01 HL47540)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年以来一直由NHLBI(最初是R01)支持的一系列工作，由哥伦比亚大学医学中心(CUMC)和石溪大学(Stony Brook University)的一个成熟的多学科调查小组进行。我们已经确定了“掩蔽性高血压”(MHT)，即临床血压正常，但平均白天动态血压高于高血压阈值的情况。虽然传统的血压测量标准不能诊断MHT，但从横断面上看，它与靶器官损伤增加有关。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。拟议的PPG将调查MHT对以下方面的贡献：a)未来血压升高和Lb)靶器官损害的进展(项目1，前瞻性队列研究)；2)与MHT相关的心理生理机制(S)(项目2，心理生理学实验室反应/恢复机制研究)；以及3)以具有成本效益的方式改进高血压诊断的策略(项目3，决策科学研究)。如果要以符合成本效益的方式确定MHT患者以进行进一步的监测和/或治疗，以及如果我们要了解MHT的机制和临床后遗症，这项研究计划是至关重要的。我们目前MHT研究的参与者将被前瞻性地跟踪，一些参与者将被招募参加项目2。项目3的参与者将从一般人群和中华医学会的初级保健诊所招募。他们将构成一个新的样本，根据临床血压标准对高血压前期或未经治疗的1期高血压患者进行过度抽样。这份建议的P01将通过大幅增加我们对MHT的临床后遗症和这种情况背后的机制的了解，并通过应用决策科学方法来开发大幅改进的算法来诊断高血压和确定哪些人最有可能从治疗中受益，从而解决NHLBI的目标和目标。我们相信，我们的发现可能会对临床上常规测量血压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.