Faculty Bibliography

Apparent treatment-resistant hypertension (aTRH) is associated with adverse cardiovascular outcomes. aTRH is common and disproportionately affects African Americans. The objective of this study is to explore psychosocial correlates of aTRH in a population-based cohort of African Americans with hypertension. The sample included 1392 participants in the Jackson Heart Study with treated hypertension who reported being adherent to their antihypertensive medications. aTRH was defined as uncontrolled clinic BP (140/90 mm Hg) with 3 classes of antihypertensive medication or treatment with 4 classes of antihypertensive medication, including a diuretic. Self-reported medication adherence was defined as taking all prescribed antihypertensive medication in the 24 h before the study visit. The association of psychosocial factors (chronic stress, depressive symptoms, perceived social support and social network) with aTRH was evaluated using Poisson regression with progressive adjustment for demographic, clinical and behavioural factors. The prevalence of aTRH was 15.1% (n=210). Participants with aTRH had lower social network scores (that is, fewer sources of regular social contact) compared with participants without aTRH (P<0.01). No other psychosocial factors differed between groups. Social network was also the only psychosocial factor that was associated with aTRH prevalence in regression analyses. In age-, sex-adjusted and fully adjusted models, one additional unique source of social contact was associated with a 19% (PR=0.81; 95% confidence interval (CI): 0.68-0.94, P=0.001) and a 13% (PR=0.87; 95% CI 0.74-1.0, P=0.041) lower prevalence of aTRH, respectively. Social network was independently associated with aTRH and warrants further investigation as a potentially modifiable determinant of aTRH in African Americans.Journal of Human Hypertension advance online publication, 26 January 2017; doi:10.1038/jhh.2016.100.

Background -Ambulatory blood pressure (BP) monitoring (ABPM) is the reference standard for out-of-clinic BP measurement. Thresholds for identifying ambulatory hypertension (daytime systolic BP [SBP]/diastolic BP [DBP] >/= 135/85 mmHg, 24-hour SBP/DBP >/= 130/80 mmHg, and nighttime SBP/DBP >/= 120/70 mmHg) have been derived from European, Asian and South American populations. We determined BP thresholds for ambulatory hypertension in a US population-based sample of African Americans. Methods -We analyzed data from the Jackson Heart Study (JHS), a population-based cohort study comprised exclusively of African-American adults (n=5,306). Analyses were restricted to 1,016 participants who completed ABPM at baseline in 2000-2004. Mean systolic BP (SBP) and diastolic BP (DBP) levels were calculated for daytime (10:00am-8:00pm), 24-hour (all available readings) and nighttime (midnight-6:00am) periods, separately. Daytime, 24-hour, and nighttime BP thresholds for ambulatory hypertension were identified using regression- and outcome-derived approaches. The composite of a cardiovascular disease (CVD) or all-cause mortality event was used in the outcome-derived approach. For this latter approach, BP thresholds were identified only for SBP as clinic DBP was not associated with the outcome. Analyses were stratified by antihypertensive medication use. Results -Among participants not taking antihypertensive medication, the regression-derived thresholds for daytime, 24-hour, and nighttime SBP/DBP corresponding to clinic SBP/DBP of 140/90 mmHg were 134/85 mmHg, 130/81 mmHg, and 123/73 mmHg, respectively. The outcome-derived thresholds for daytime, 24-hour, and nighttime SBP corresponding to a clinic SBP >/= 140 mmHg were 138 mmHg, 134 mmHg, and 129 mmHg, respectively. Among participants taking antihypertensive medication, the regression-derived thresholds for daytime, 24-hour, and nighttime SBP/DBP corresponding to clinic SBP/DBP of 140/90 mmHg were 135/85 mmHg, 133/82 mmHg, and 128/76 mmHg, respectively. The corresponding outcome-derived thresholds for daytime, 24-hour, and nighttime SBP were 140 mmHg, 137 mmHg, and 133 mmHg, respectively, among those taking antihypertensive medication. Conclusions -Based on the outcome-derived approach for SBP and regression-derived approach for DBP, the following definitions for daytime hypertension, 24-hour hypertension, and nighttime hypertension corresponding to clinic SBP/DBP >/= 140/90 mmHg are proposed for African Americans: daytime SBP/DBP >/= 140/85 mmHg, 24-hour SBP/DBP >/= 135/80 mmHg, and nighttime SBP/DBP >/= 130/75 mmHg, respectively.

BACKGROUND: Clinical guidelines recommend using predicted atherosclerotic cardiovascular disease (ASCVD) risk to inform treatment decisions. The objective was to compare the contribution of changes in modifiable risk factors versus aging to the development of high 10-year predicted ASCVD risk. METHODS AND RESULTS: A prospective follow-up was done of the Jackson Heart Study, an exclusively black cohort at visit 1 (2000-2004) and visit 3 (2009-2012). Analyses included 1115 black participants without high 10-year predicted ASCVD risk (<7.5%), hypertension, diabetes mellitus, or ASCVD at visit 1. We used the Pooled Cohort equations to calculate the incidence of high (>/=7.5%) 10-year predicted ASCVD risk at visit 3. We recalculated the percentage with high 10-year predicted ASCVD risk at visit 3 assuming each risk factor (age, systolic blood pressure, antihypertensive medication use, diabetes mellitus, smoking, total and high-density lipoprotein cholesterol), one at a time, did not change from visit 1. The mean age at visit 1 was 45.2+/-9.5 years. Overall, 30.9% (95% CI 28.3-33.4%) of participants developed high 10-year predicted ASCVD risk. Aging accounted for 59.7% (95% CI 54.2-65.1%) of the development of high 10-year predicted ASCVD risk compared with 32.8% (95% CI 27.0-38.2%) for increases in systolic blood pressure or antihypertensive medication initiation and 12.8% (95% CI 9.6-16.5%) for incident diabetes mellitus. Among participants <50 years, the contribution of increases in systolic blood pressure or antihypertensive medication initiation was similar to aging. CONCLUSIONS: Increases in systolic blood pressure and antihypertensive medication initiation are major contributors to the development of high 10-year predicted ASCVD risk in blacks, particularly among younger adults.

BACKGROUND: African Americans exhibit a lower degree of nocturnal blood pressure (BP) dipping compared with Whites, but the reasons for reduced BP dipping in this group are not fully understood. The aim of this study was to identify psychosocial factors associated with BP dipping in a population-based cohort of African Americans. METHODS: This cross-sectional study included 668 Jackson Heart Study (JHS) participants with valid 24-hour ambulatory BP data and complete data on psychosocial factors of interest including stress, negative emotions, and psychosocial resources (e.g., perceived support). The association of each psychosocial factor with BP dipping percentage and nondipping status (defined as <10% BP dipping) was assessed using linear and Poisson regression models, respectively, with progressive adjustment for demographic, socioeconomic, biomedical, and behavioral factors. RESULTS: The prevalence of nondipping was 64%. Higher depressive symptoms, higher hostility, and lower perceived social support were associated with a lower BP dipping percentage in unadjusted models and after adjustment for age, sex, body mass index, and mean 24-hour systolic BP (P < 0.05). Only perceived support was associated with BP dipping percentage in fully adjusted models. Also, after full multivariable adjustment, the prevalence ratio for nondipping BP associated with 1 SD (7.1 unit) increase in perceived support was 0.93 (95% CI: 0.88-0.99). No other psychosocial factors were associated with nondipping status. CONCLUSIONS: Lower perceived support was associated with reduced BP dipping in this study. The role of social support as a potentially modifiable determinant of nocturnal BP dipping warrants further investigation.

This study evaluated the psychobehavioral benefits of the Children's Lives Include Moments of Bravery (CLIMB(R)) intervention in 45 children (aged 6-11) with a parent/caregiver with cancer. Parent/caregiver reports of psychobehavioral functioning indicated signi-ficant decreases in children's emotional symptoms and marginally significant reductions in conduct problems. Child reports of emotion regulation indicated significant increases in emotion awareness, significant decreases in emotion suppression, and nonsignificant increases in emotion-focused coping and dysregulated expression. Parents/caregivers and children reported high satisfaction with CLIMB(R). Results suggest CLIMB(R) is a promising intervention for improving psychobehavioral functioning and emotion regulation in children with a parent/caregiver with cancer.

The current study examined whether negative illness perceptions help explain the link between depression and quality of life. Seventy patients with epilepsy completed standardized self-report questionnaires measuring depression, illness perception, and quality of life (QOL). Illness perception statistically mediated the relationship between depression and QOL (Indirect effect (CI; confidence interval) = -.72, lower limit = -1.7, upper limit = -.22, p < .05). Results held with and without adjusting for potential confounding variables (age, sex, ethnicity, income, and seizure frequency) and when operationalizing depression as a continuous variable that indexed severity of symptoms or as a dichotomous variable that indexed criteria consistent with a diagnosis of major depressive disorder. This study is the first to suggest that illness perceptions may be a useful target in screening and intervention approaches in order to improve QOL among low-income, racially/ethnically diverse patients with epilepsy.