# Health Disparities in Hypertension: A Precision Medicine-based Approach for Early Risk Stratification and Prevention

> **NIH NIH U54** · YALE UNIVERSITY · 2020 · $340,385

## Abstract

Hypertension (HTN) is one of the most preventable causes of cardiovascular and cerebrovascular disease,
and one of the most important contributors to health disparities. Precision Medicine - with the associated
attention to individual variability in living environment, to the experience of and the responses to this
environment, to lifestyle, and to other contextual factors that act at the level of the individual and influence HTN
risk - may hold the greatest promise for promoting health equity and reducing health disparities in HTN risk.
Contextual factors can profoundly affect daytime ambulatory blood pressure measurement (ABPM), which is
more closely associated with HTN risk than the resting clinic BP (CBP). ABPM provides a window into the
‘personal’ factors that influence BP during the day, and an earlier signal of HTN risk through the identification
of individuals with “nondipping” nocturnal BP, and with masked hypertension (MHT), a condition defined by
hypertensive ABPM and normotensive CBP. Among the key factors for health disparities that may influence
ABPM are exposure to racism, neighborhood environment and noise, and level of social support. While
research has repeatedly shown these effects, health disparities persist, in large part because clinical care has
not yet found a way to incorporate these factors for risk prediction and treatment at the individual level. We
propose to examine momentary ambulatory blood pressure (ABPM) in relation to individual variability in
environment, lifestyle, and related contextual factors, in the NIMHD-funded Eastern Caribbean Health
Outcomes Research Network (ECHORN), a previously defined cohort of individuals of African and Hispanic
descent at high HTN risk. We will develop individual level phenotypes of HTN risk, based on contextual
factors and the momentary effects these have on ABP, using advanced analytic techniques. Specific Aims:
1.To examine the clustering of contextual factors captured using ecological momentary assessment (EMA),
validated questionnaires, information about the built environment, and actigraphy data on sleep – with
momentary ABP over 24-hours; 2. To prospectively assess the contribution of contextual factors to
trajectories of ABP over time, using advanced computational techniques to characterize contextual
phenotypes associated with ABP trajectory over 2-years. Hypotheses: 1. Patterns of contextual factors
associated with ABPM will define phenotypes of individuals with varying HTN risk. 2. Longitudinally assessed
contextual phenotype will predict 2-year BP trajectories, i.e., changes in ABPM and resting CBP.
Significance. By identifying actionable, individual level factors that increase HTN risk, the results of the
proposed study will address a critical knowledge gap concerning health disparities and directly lead to the
development of Precision Medicine based screening tools and risk prediction models to inform personalized
intervention strategies for individuals at highest r...

## Key facts

- **NIH application ID:** 9972763
- **Project number:** 5U54MD010711-05
- **Recipient organization:** YALE UNIVERSITY
- **Principal Investigator:** Erica Sarah Spatz
- **Activity code:** U54 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $340,385
- **Award type:** 5
- **Project period:** — → 2023-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9972763

## Citation

> US National Institutes of Health, RePORTER application 9972763, Health Disparities in Hypertension: A Precision Medicine-based Approach for Early Risk Stratification and Prevention (5U54MD010711-05). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9972763. Licensed CC0.

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