Perseverative Cognitions: Assessment and Associations with Stress, Sleep and BP

描述（由申请人提供）：心理压力与高血压（HTN）的发展有关，但其发生的过程知之甚少。长期的血压（BP）对压力的反应已被证明会增加HTN的风险，而且越来越多的证据表明，除了直接经历压力之外，思考压力经历也会影响血压。因此，有假设认为，参与对过去或未来压力源的持续性认知可能有助于延长生理激活，并随着时间的推移，HTN的发展。有证据表明，持续性认知与延迟的血压恢复和睡眠质量受损有关，这两者都增加了HTN的风险，为这一假设提供了初步支持。然而，这一新兴领域的进展受到若干重要概念和方法问题的限制。人们对现实世界中持续性认知的本质知之甚少：人们对压力事件的反思有多少，哪些因素影响了这种想法的可能性，它们对睡眠和血压有什么影响？此外，要被认为是一个可能的风险因素，必须证明持久性认知的个体差异存在并随着时间的推移而稳定。这些问题最好使用生态瞬时评估（EMA）来解决。提议的R21的目标是解决这些问题，为未来的应用做准备，我们将进行更大、更深入的研究，以正式测试假设的模型。我们将进行一项EMA研究，在该研究中，163名血压正常和未经治疗的高血压受试者将接受基于电子日记的每日压力暴露和持续性认知评估，活动记录仪和动态血压监测，为期2周。目的是：(1)确定使用扩展的EMA方案同时评估自然环境下应激暴露、持续性认知、睡眠质量和血压的可行性；(2)量化被试的日常压力暴露和持续性认知体验，并探讨它们是否因情境和/或个人因素而存在差异；(3)评估应激暴露和持续性认知在2周内的稳定性，并估计可靠评估两者所需的监测时间；(4)探索性分析日常压力和持续性认知与睡眠质量和血压的关系，为未来的研究提供效应量估计。公共卫生意义：超过28%的美国人口患有HTN，这仍然是发病率和死亡率的主要原因。心理压力会增加HTN的风险，了解其中的机制可能会改善干预措施。这项研究将填补文献中的重要空白，并为设计更大的研究提供关键信息，以确定持续性认知在压力、睡眠受损和血压升高之间的关系中的作用。这些发现也将广泛适用于设计压力和与压力有关的思想对健康的其他影响的调查。

DESCRIPTION (provided by applicant): Psychological stress has been linked to the development of hypertension (HTN) but the process by which this occurs is poorly understood. Prolonged blood pressure (BP) responses to stress have been shown to increase risk for HTN, and there is growing evidence indicating that thinking about stressful experiences, in addition to experiencing them directly, can affect BP. Thus, it has been hypothesized that engaging in perseverative cognitions about past or future stressors may contribute to prolonged physiological activation and, over time, the development of HTN. Evidence that perseverative cognitions are associated with delayed BP recovery and impaired sleep quality, which both increase HTN risk, provides preliminary support for the hypothesis. However, progress in this emerging field has been limited by several important conceptual and methodological issues. Little is known about the nature of perseverative cognition in the real world: how much do people ruminate about stressful events, what factors influence the likelihood of engaging in such thoughts, and what are their effects on sleep and BP? Also, to be considered as a possible risk factor, it must be demonstrated that individual differences in perseverative cognition exist and are stable over time. These questions can best be addressed using ecological momentary assessment (EMA). The goal of the proposed R21 is to resolve these issues in preparation for a future application in which we will conduct a larger, more intensive study to formally test the hypothesized model. We will conduct an EMA study in which a diverse sample of 163 normotensive and untreated hypertensive subjects will undergo electronic diary-based assessment of daily stress exposure and perseverative cognitions, actigraphy and ambulatory BP monitoring over a 2-week period. The aims are: (1) To determine the feasibility of using an extended EMA protocol to simultaneously assess stress exposure, perseverative cognitions, sleep quality and BP in the natural environment; (2) To quantify subjects' exposure to daily stress and their experience of perseverative cognitions and explore whether these differ according to situational and/or person-level factors; (3) To assess the stability of stress exposure and perseverative cognitions over a 2-week period, and to estimate the duration of monitoring required to reliably assess each; and (4) To conduct exploratory analyses of associations of daily stress and perseverative cognitions with sleep quality and BP, which will provide effect size estimates to inform future studies. Public Health Significance: More than 28% of the U.S. population has HTN, which continues to be a major cause of morbidity and mortality. Psychological stress increases HTN risk, and understanding the mechanisms involved may lead to improved interventions. This study will address important gaps in the literature and provide critical information for the design of a larger study to determine the role of perseverative cognition in the relationships between stress, impaired sleep and elevated BP. The findings will also be broadly applicable to the design of investigations of other health effects of stress and stress-related thoughts.