Outcomes include cardiovascular events, ambulatory and home blood pressure, and ecological momentary assessment of cognitions and emotions.
Outcomes include noninvasive continuous blood pressure monitoring, assessment of heart rate variability, platelet activation, endothelial-dependent and independent vasomotor function, circulating neuro-hormones, and inflammatory markers.
Randomized Controlled Trials
Outcomes include cardiovascular events and home blood pressure, and adherence to prescribed medication regimens, assessed using electronic monitoring.
The Center for Behavioral Cardiovascular Health research program began by focusing on understanding the causes of Essential Hypertension, and studying its treatment. In the past 5 years, the CBCH has broadened its interests from hypertension to heart disease. Dr. Karina Davidson has specialized in one of the most engaging problems in cardiology today: the role of depression. A large number of studies now show that depressed persons are at increased risk for a myocardial infarction (M.I., commonly known as a heart attack). The reasons for this phenomenon remain unclear, however, and it is not certain whether depression plays a causal role in heart disease or whether both depression and heart disease stem from some other, possibly unknown, cause. Dr. Davidson is Director and Principal Investigator of COPES (Coronary Psychosocial Evaluation Study), a multi-site study funded by NHLBI/NIH to study the nature of the depression that may lead to cardiac disease, and a possible intervention that may serve to prevent such disease. The trial ended in 2009, and has already provided significant insight into the role that depression may play in the development of heart disease. Dr. Matthew Burg plays a key role on the project, and is the Principal Investigator of COPES at Yale University, one of the key sites where the study is being conducted. Based on the ground-breaking work done under this study, Dr. Davidson and the team at CBCH was awarded a program project grant, PULSE (Prescription Use, Lifestyle, and Stress Evaluation), to delve deeper into the biological and behavioral mechanisms through which depression increases Major Acute Coronary Event /Acute Coronary Event (MACE/ACM) risk in Acute Coronary Syndrome patients. Dr Davidson has also been awarded funding by NHLBI for a multi-center feasibility/vanguard study, the Comparison of Depression Interventions after Acute Coronary Syndrome (CODIACS) study. This aims to assess the feasibility and estimate the effectiveness of an enhanced care intervention relative to standard care for depressive symptoms in 150 persistently depressed (2-months) post-ACS patients.
We are also interested in the way in which psychological states such as molecular biology, cell motility and cytoskeleton, tissue/organ rejection and genetics influence cardiovascular disease. Dr. Daichi Shimbo, a Board-Certified cardiologist, is the Principal Investigator on the NHLBI/NIH funded grant which examines the relations among depression, telomere length, and 10-year incident cardiovascular events in a population-based study. As part of the Irving Scholars Program, Dr Shimbo is also leading a translational study whose goal is to examine the effect of anger induction on endothelial cell injury, and oxidative stress.
We continue to conduct many studies in the area of hypertension. Many of the causes of hypertension are associated with lifestyle, and we have concentrated our research efforts in this area. Since the causes and treatment of hypertension cannot be addressed without a reliable diagnosis, we have also focused on how blood pressure (BP) is measured. Thus, for example, Dr. Thomas Pickering, who was Director of CBCH until May 2009, was one of the first investigators to point out the several causes of inaccuracy of blood pressure measurements that occur when physicians take measurements. To address this problem, he pioneered the use of ambulatory blood pressure monitoring, a procedure in which the patient wears a portable device that monitors the blood pressure while patients go about their daily activities. This procedure holds several advantages. One of them, identified many years ago by Dr. Pickering, is that the blood pressure of many patients tends to be high when taken by the physician, but is normal at most other times. This has been called “White Coat Hypertension” (due to the effect of the physician’s white coat), and can lead to false diagnosis of hypertension and to unnecessary medication. A study by Dr. Pickering funded by the National Heart, Lung and Blood Institute (NHLBI) of NIH made real progress in ascertaining the causes of white coat hypertension, and the role of that anxiety may play in this mis-diagnosis.
In his studies of the measurement of blood pressure, Dr. Pickering also discovered that patients whose BP appears to be normal in the physician’s office may actually be hypertensive when measured by ambulatory BP. He defined this condition as “masked hypertension”. Dr. Schwartz, a long-time collaborator of the group, joined the CBCH faculty in 2008 and since 2003 has led the Masked Hypertension Study in which the mechanisms, clinical sequelae, and cost-effective diagnosis of masked hypertension are investigated. Dr Schwartz also heads the program project grant on the psychosocial determinants of hypertension and cardiovascular risk.
Although anti-hypertensive medication has the means by which to control a large proportion (estimated 60 percent) of hypertensive patients’ blood pressure, many patients do not respond well to these medicines, and non-pharmacological interventions may improve blood pressure control in these patients. Diet, exercise, anger-management, and stress-reduction have all been shown to be effective in reducing blood pressure, but, as with medications, adherence is a large barrier to the effectiveness of these interventions. Our group has specialized in testing alternative approaches to hypertension management, and in testing the extent to which patients will use them.
We also use other interventions to attempt to lower blood pressure or improve control of hypertension. Dr. Lynn Clemow recently completed a study testing and anger-management intervention that was open to all Columbia University employees. This trial was sponsored by NHLBI/NIH. The treatment consisted of several group sessions to teach participants how to express their anger in productive ways in order to solve their problems, rather than simply attempt to vent frustration and possibly exacerbate the situation. Dr. Clemow is also conducting a study (also supported by NHLBI) to study the role of controlled breathing, a procedure that has been found to slow heart rate and blood pressure, and to produce a conditioned relaxation response, to treat blood pressure in hypertensive patients.