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Hypertension: HELP
Articles by Jonathan N. Tobin
Based on 11 articles published since 2010
(Why 11 articles?)
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Between 2010 and 2020, Jonathan Tobin wrote the following 11 articles about Hypertension.
 
+ Citations + Abstracts
1 Review Research Needs to Improve Hypertension Treatment and Control in African Americans. 2016

Whelton, Paul K / Einhorn, Paula T / Muntner, Paul / Appel, Lawrence J / Cushman, William C / Diez Roux, Ana V / Ferdinand, Keith C / Rahman, Mahboob / Taylor, Herman A / Ard, Jamy / Arnett, Donna K / Carter, Barry L / Davis, Barry R / Freedman, Barry I / Cooper, Lisa A / Cooper, Richard / Desvigne-Nickens, Patrice / Gavini, Nara / Go, Alan S / Hyman, David J / Kimmel, Paul L / Margolis, Karen L / Miller, Edgar R / Mills, Katherine T / Mensah, George A / Navar, Ann M / Ogedegbe, Gbenga / Rakotz, Michael K / Thomas, George / Tobin, Jonathan N / Wright, Jackson T / Yoon, Sung Sug Sarah / Cutler, Jeffrey A / Anonymous7660880. ·From the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine (P.K.W., K.C.F.), and Department of Medicine, Tulane University School of Medicine (P.K.W., K.C.F.), New Orleans, LA · Division of Cardiovascular Sciences (P.T.E., P.D.-N., G.A.M., J.A.C.), and Center for Translation Research and Implementation Science (N.G., G.A.M.), National Heart, Lung, and Blood Institute, Bethesda, MD · Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (P.M.) · Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (L.J.A., L.A.C., E.R.M.) · Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.) · Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA (A.V.D.R.) · Department of Medicine, Case Western Reserve University, University Hospitals Case Medical Center, Louis Stokes Cleveland VA Medical Center, OH (M.R., J.T.W.) · Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, GA (H.A.T.) · Department of Epidemiology and Prevention (J.A.) and Department of Medicine (B.I.F., J.A.), Wake Forest School of Medicine, Wake Forest University, Winston Salem, NC · Dean's Office, University of Kentucky College of Public Health, Lexington (D.K.A.) · Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City (B.L.C.) · Department of Biostatistics, University of Texas School of Public Health, Houston (B.R.D.) · Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL (R.C.) · Division of Research, Kaiser Permanente Northern California, Oakland (A.S.G.) · Department of Internal Medicine, Baylor College of Medicine, Houston, TX (D.J.H.) · National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (P.L.K.) · HealthPartners Institute, Minneapolis, MN (K.L.M.) · Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.M.N.) · Department of Population Health, NYU School of Medicine, New York (G.O.) · American Medical Association, Chicago, IL (M.K.R.) · Department of Nephrology and Hypertension, Cleveland Clinic, OH (G.T.) · Clinical Directors Network (CND) and The Rockefeller University Center for Clinical and Translational Science, New York (J.N.T.) · and National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD (S.S.(S.)Y.). ·Hypertension · Pubmed #27620388.

ABSTRACT: -- No abstract --

2 Clinical Trial Theoretical and Pragmatic Adaptation of the 5As Model to Patient-Centered Hypertension Counselling. 2018

Carroll, Jennifer K / Fiscella, Kevin / Cassells, Andrea / Sanders, Mechelle R / Williams, Stephen K / D'Orazio, Brianna / Holder, Tameir / Farah, Subrina / Khalida, Chamanara / Tobin, Jonathan N. · ·J Health Care Poor Underserved · Pubmed #30122677.

ABSTRACT: Patient-centered communication is a means for engaging patients in partnership. However, patient centered communication has not always been grounded in theory or in clinicians' pragmatic needs. The objective of this report is to present a practical approach to hypertension counselling that uses the 5As framework and is grounded in theory and best communication practices.

3 Article Differences in primary cardiovascular disease prevention between the 2013 and 2016 cholesterol guidelines and impact of the 2017 hypertension guideline in the United States. 2018

Egan, Brent M / Li, Jiexiang / Davis, Robert A / Fiscella, Kevin A / Tobin, Jonathan N / Jones, Daniel W / Sinopoli, Angelo. ·Care Coordination Institute, Greenville, SC, USA. · Department of Medicine, University of South Carolina School of Medicine, Greenville, SC, USA. · Department of Mathematics, College of Charleston, Charleston, SC, USA. · Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA. · Clinical Directors Network (CDN), New York, NY, USA. · Center for Clinical and Translational Science, The Rockefeller University, New York, NY, USA. · Department of Epidemiology and Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA. · Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA. · Department of Physiology & Biophysics, University of Mississippi Medical Center, Jackson, MS, USA. ·J Clin Hypertens (Greenwich) · Pubmed #29774988.

ABSTRACT: The US Preventive Services Task Force cholesterol guideline recommended statins for fewer adults than the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline by setting a higher 10-year atherosclerotic cardiovascular disease threshold (≥10.0% vs ≥7.5%) and requiring concomitant diabetes mellitus, hypertension, dyslipidemia, or cigarette smoking. The 2017 ACC/AHA hypertension guideline lowered the hypertension threshold, increasing 2016 guideline statin-eligible adults. Cross-sectional data on US adults aged 40 to 75 years enabled estimated numbers for the 2013 guideline and 2016 guideline with hypertension thresholds of ≥140/≥90 mm Hg and ≥130/80 mm Hg, respectively, on: (1) untreated, statin-eligible adults for primary atherosclerotic cardiovascular disease prevention (25.40, 14.72, 15.35 million); (2) atherosclerotic cardiovascular disease events prevented annually (124 000, 70 852, 73 199); (3) number needed to treat (21, 21, 21); and (4) number needed to harm (38, 143, 143) per 1000 patient-years for incident diabetes mellitus (42 800, 6700, 7100 cases per year). Despite the lower hypertension threshold, the 2013 cholesterol guideline qualifies approximately 10 million more adults for statins and prevents approximately 50 600 more primary atherosclerotic cardiovascular disease events but induces approximately 35 700 more diabetes mellitus cases annually than the 2016 guideline.

4 Article Lifetime racial/ethnic discrimination and ambulatory blood pressure: The moderating effect of age. 2016

Beatty Moody, Danielle L / Waldstein, Shari R / Tobin, Jonathan N / Cassells, Andrea / Schwartz, Joseph C / Brondolo, Elizabeth. ·Department of Psychology, University of Maryland, Baltimore County. · Clinical Directors Network. · Department of Psychiatry and Behavioral Science, Stony Brook University. · Department of Psychology, St. John's University. ·Health Psychol · Pubmed #27018724.

ABSTRACT: OBJECTIVE: To determine whether the relationships of lifetime discrimination to ambulatory blood pressure (ABP) varied as a function of age in a sample of Black and Latino(a) adults ages 19 - 65. METHOD: Participants were 607 Black (n = 318) and Latino(a) (n = 289) adults (49% female) who completed the Perceived Ethnic Discrimination Questionnaire-Community Version (PEDQ-CV), which assesses lifetime exposure to racism/ethnic discrimination. They were outfitted with an ABP monitor to assess systolic and diastolic blood pressure (SBP, DBP) across a 24-hr period. Mixed-level modeling was conducted to examine potential interactive effects of lifetime discrimination and age to 24-hr, daytime, and nighttime ABP after adjustment for demographic, socioeconomic, personality and life stress characteristics, and substance consumption covariates (e.g., smoking, alcohol). RESULTS: There were significant interactions of Age × Lifetime Discrimination on 24-hr and daytime DBP (ps ≤ .04), and in particular significant interactions for the Social Exclusion component of Lifetime Discrimination. Post hoc probing of the interactions revealed the effects of Lifetime Discrimination on DBP were seen for older, but not younger participants. Lifetime discrimination was significantly positively associated with nocturnal SBP, and these effects were not moderated by age. All associations of Lifetime Discrimination to ABP remained significant controlling for recent exposure to discrimination as well as all other covariates. CONCLUSIONS: Exposure to racial/ethnic discrimination across the life course is associated with elevated ABP in middle to older aged Black and Latino(a) adults. Further research is needed to understand the mechanisms linking discrimination to ABP over the life course. (PsycINFO Database Record

5 Article Predictors of Changes in Medication Adherence in Blacks with Hypertension: Moving Beyond Cross-Sectional Data. 2016

Schoenthaler, Antoinette M / Butler, Mark / Chaplin, William / Tobin, Jonathan / Ogedegbe, Gbenga. ·Center for Healthful Behavior Change, Division of Health & Behavior, Department of Population Health, New York University School of Medicine, 227 East 30th Street, 634, New York, NY, 10016, USA. antoinette.schoenthaler@nyumc.org. · Center for Healthful Behavior Change, Division of Health & Behavior, Department of Population Health, New York University School of Medicine, 227 East 30th Street, New York, NY, 10016, USA. · Department of Psychology, St. John's University, Queens, NY, 11439, USA. · Clinical Directors Network, Inc. (CDN), New York, NY, USA. · The Rockefeller University, New York, NY, USA. · Center for Healthful Behavior Change, Division of Health & Behavior, Department of Population Health, New York University School of Medicine, 227 East 30th Street, 633, New York, NY, 10016, USA. ·Ann Behav Med · Pubmed #26944584.

ABSTRACT: BACKGROUND: Many studies have examined the multiple correlates of non-adherence in Blacks. However, they are largely cross-sectional; thus, these studies are unable to examine their predictive value on long-term medication adherence. PURPOSE: The purpose of this study is to examine the predictive role of key psychosocial and interpersonal factors on changes in medication adherence over a 1-year period. METHODS: Data were collected from 815 Black patients with hypertension followed in community health centers. Hypothesized predictor variables included self-efficacy, depressive symptoms, social support, and patient-provider communication measured at baseline, 6, and 12 months. The dependent variable, medication adherence was assessed at baseline, 6, and 12 months. Latent Growth Modeling was used to evaluate the pathways between the latent predictor variables and medication adherence. RESULTS: Participants were mostly female, low-income, with high school education or less, and mean age of 57 years. At baseline, high self-efficacy was associated with low depressive symptoms (β = -0.22, p = 0.05), collaborative patient-provider communication (β = 0.17, p = 0.006), and better medication adherence (β = 1.04, p < 0.001). More social support and collaborative patient-provider communication were associated with low depressive symptoms (β = -0.08, p = 0.02; β = -0.18, p = 0.01). More social support was positively associated with collaborative patient-provider communication (β = 0.32, p < 0.001). In the longitudinal model, increasing self-efficacy over time predicted improvements in medication adherence 1 year later (β = 1.76, p < 0.001; CFI = 0.95; RMSEA = 0.04; SRMR = 0.04; Chi-Squared Index of Model Fit = 1128.54). CONCLUSIONS: Self-efficacy is a key predictor of medication adherence over time in Black patients with hypertension. Initial levels of self-efficacy are influenced by the presence of depressive symptoms as well as the perceived quality of patient-provider communication.

6 Article Effect of Expectation of Care on Adherence to Antihypertensive Medications Among Hypertensive Blacks: Analysis of the Counseling African Americans to Control Hypertension (CAATCH) Trial. 2016

Grant, Andrea Barnes / Seixas, Azizi / Frederickson, Keville / Butler, Mark / Tobin, Jonathan N / Jean-Louis, Girardin / Ogedegbe, Gbenga. ·Department of Nursing, Graduate Center, City University of New York, New York, NY. · Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY. · Department of Population Health, Division of Health and Behavior, Center for Healthful Behavior Change, New York University Medical Center, New York, NY. · Pace University, College of Health Professions, Lienhard School of Nursing, Pleasantville, NY. · Clinical Directors Network, New York, NY. · Department of Epidemiology and Population Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY. · Center for Clinical and Translational Science, the Rockefeller University, New York, NY. ·J Clin Hypertens (Greenwich) · Pubmed #26593105.

ABSTRACT: Novel ideas are needed to increase adherence to antihypertensive medication. The current study used data from the Counseling African Americans to Control Hypertension (CAATCH) study, a sample of 442 hypertensive African Americans, to investigate the mediating effects of expectation of hypertension care, social support, hypertension knowledge, and medication adherence, adjusting for age, sex, number of medications, diabetes, education, income, employment, insurance status, and intervention. Sixty-six percent of patients had an income of $20,000 or less and 56% had a high school education or less, with a mean age of 57 years. Greater expectation of care was associated with greater medication adherence (P=.007), and greater social support was also associated with greater medication adherence (P=.046). Analysis also showed that expectation of care mediated the relationship between hypertension knowledge and medication adherence (P<.05). Expectation of care and social support are important factors for developing interventions to increase medication adherence among blacks.

7 Article Blood Pressure Visit Intensification Study in Treatment: Trial design. 2015

Fiscella, Kevin / Ogedegbe, Gbenga / He, Hua / Carroll, Jennifer / Cassells, Andrea / Sanders, Mechelle / Khalida, Chamanara / D'Orazio, Brianna / Tobin, Jonathan N. ·Department of Family Medicine, University of Rochester Medical Center, Rochester, NY. Electronic address: kevin_fiscella@urmc.rochester.edu. · Department of Population Health, Langone Medical Center, New York University, New York, NY. · Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA. · Department of Family Medicine, University of Rochester Medical Center, Rochester, NY. · Clinical Directors Network (CDN), New York, NY. · Clinical Directors Network (CDN), New York, NY; Albert Einstein College of Medicine of Yeshiva University/Montefiore Medical Center, Bronx, NY; The Rockefeller University Center for Clinical and Translational Science, New York, NY. ·Am Heart J · Pubmed #26678642.

ABSTRACT: BACKGROUND: There is a presumption that, for patients with uncontrolled blood pressure (BP), early follow-up, that is, within 4 weeks of an elevated reading, improves BP control. However, data are lacking regarding effective interventions for increasing clinician frequency of follow-up visits and whether such interventions improve BP control. METHODS/DESIGN: Blood Pressure Visit Intensification Study in Treatment involves a multimodal approach to improving intensity of follow-up in 12 community health centers using a stepped wedge study design. DISCUSSION: The study will inform effective interventions for increasing frequency of follow-up visits among patients with uncontrolled BP and determine whether increasing follow-up frequency is associated with better BP control.

8 Article Designing and evaluating health systems level hypertension control interventions for African-Americans: lessons from a pooled analysis of three cluster randomized trials. 2015

Pavlik, Valory N / Chan, Wenyaw / Hyman, David J / Feldman, Penny / Ogedegbe, Gbenga / Schwartz, Joseph E / McDonald, Margaret / Einhorn, Paula / Tobin, Jonathan N. ·Clinical Directors Network, Inc. (CDN), New York, NY 10018; Department of Epidemiology and Population Health, Albert Einstein College of Medicine of Yeshiva University/ Montefiore Medical Center, Bronx, NY 10461. vpavlik@bcm.edu. ·Curr Hypertens Rev · Pubmed #25808682.

ABSTRACT: OBJECTIVES: African-Americans (AAs) have a high prevalence of hypertension and their blood pressure (BP) control on treatment still lags behind other groups. In 2004, NHLBI funded five projects that aimed to evaluate clinically feasible interventions to effect changes in medical care delivery leading to an increased proportion of AA patients with controlled BP. Three of the groups performed a pooled analysis of trial results to determine: 1) the magnitude of the combined intervention effect; and 2) how the pooled results could inform the methodology for future health-system level BP interventions. METHODS: Using a cluster randomized design, the trials enrolled AAs with uncontrolled hypertension to test interventions targeting a combination of patient and clinician behaviors. The 12-month Systolic BP (SBP) and Diastolic BP (DBP) effects of intervention or control cluster assignment were assessed using mixed effects longitudinal regression modeling. RESULTS: 2,015 patients representing 352 clusters participated across the three trials. Pooled BP slopes followed a quadratic pattern, with an initial decline, followed by a rise toward baseline, and did not differ significantly between intervention and control clusters: SBP linear coefficient = -2.60±0.21 mmHg per month, p<0.001; quadratic coefficient = 0.167± 0.02 mmHg/month, p<0.001; group by time interaction group by time group x linear time coefficient=0.145 ± 0.293, p=0.622; group x quadratic time coefficient= -0.017 ± 0.026, p=0.525). RESULTS were similar for DBP. The individual sites did not have significant intervention effects when analyzed separately. CONCLUSION: Investigators planning behavioral trials to improve BP control in health systems serving AAs should plan for small effect sizes and employ a "run-in" period in which BP can be expected to improve in both experimental and control clusters.

9 Article Counseling African Americans to Control Hypertension: cluster-randomized clinical trial main effects. 2014

Ogedegbe, Gbenga / Tobin, Jonathan N / Fernandez, Senaida / Cassells, Andrea / Diaz-Gloster, Marleny / Khalida, Chamanara / Pickering, Thomas / Schwartz, Joseph E. ·From the Division of Health and Behavior and Center for Healthful Behavior Change, Department of Population Health, New York University Langone Medical Center, New York, NY (G.O., S.F.) · Clinical Directors Network, New York, NY (J.N.T., A.C., M.D.-G., C.K.) · Department of Epidemiology and Population Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY (J.N.T.) · Center for Clinical and Translational Science, Rockefeller University, New York, NY (J.N.T.) · Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY (T.P., J.E.S.) · Department of Psychiatry and Behavioral Science, Stony Brook University, Stony Brook, NY (J.E.S.). ·Circulation · Pubmed #24657991.

ABSTRACT: BACKGROUND: Data are limited on the implementation of evidence-based multilevel interventions targeted at blood pressure (BP) control in hypertensive blacks who receive care in low-resource primary care practices. METHODS AND RESULTS: Counseling African Americans to Control Hypertension is a cluster-randomized clinical trial in which 30 community health centers were randomly assigned to the intervention condition (IC) or usual care (UC). Patients at the IC sites received patient education, home BP monitoring, and monthly lifestyle counseling, whereas physicians attended monthly hypertension case rounds and received feedback on their patients' home BP readings and chart audits. Patients and physicians at the UC sites received printed patient education material and hypertension treatment guidelines, respectively. The primary outcome was BP control, and secondary outcomes were mean changes in systolic and diastolic BPs at 12 months, assessed with an automated BP device. A total of 1059 patients (mean age, 56 years; 28% men, 59% obese, and 36% with diabetes mellitus) were enrolled. The BP control rate was similar in both groups (IC=49.3% versus UC=44.5%; odds ratio, 1.21 [95% confidence interval, 0.90-1.63]; P=0.21). In prespecified subgroup analyses, the intervention was associated with greater BP control in patients without diabetes mellitus (IC=54.0% versus UC=44.7%; odds ratio, 1.45 [confidence interval, 1.02-2.06]); and small-sized community health centers (IC=51.1% versus UC=39.6%; odds ratio, 1.45 [confidence interval, 1.04-2.45]). CONCLUSIONS: A practice-based, multicomponent intervention was no better than UC in improving BP control among hypertensive blacks. Future research on the implementation of behavioral modification strategies for hypertension control in low-resource settings should focus on the development of more efficient and tailored interventions in this high-risk population. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00233220.

10 Article The counseling African Americans to Control Hypertension (CAATCH) Trial: baseline demographic, clinical, psychosocial, and behavioral characteristics. 2011

Fernandez, Senaida / Tobin, Jonathan N / Cassells, Andrea / Diaz-Gloster, Marleny / Kalida, Chamanara / Ogedegbe, Gbenga. ·Center for Healthful Behavior Change, Division of General Internal Medicine, Department of Medicine, New York University School of Medicine, 550 First Avenue, New York, NY, USA. ·Implement Sci · Pubmed #21884616.

ABSTRACT: BACKGROUND: Effectiveness of combined physician and patient-level interventions for blood pressure (BP) control in low-income, hypertensive African Americans with multiple co-morbid conditions remains largely untested in community-based primary care practices. Demographic, clinical, psychosocial, and behavioral characteristics of participants in the Counseling African American to Control Hypertension (CAATCH) Trial are described. CAATCH evaluates the effectiveness of a multi-level, multi-component, evidence-based intervention compared with usual care (UC) in improving BP control among poorly controlled hypertensive African Americans who receive primary care in Community Health Centers (CHCs). METHODS: Participants included 1,039 hypertensive African Americans receiving care in 30 CHCs in the New York Metropolitan area. Baseline data on participant demographic, clinical (e.g., BP, anti-hypertensive medications), psychosocial (e.g., depression, medication adherence, self-efficacy), and behavioral (e.g., exercise, diet) characteristics were gathered through direct observation, chart review, and interview. RESULTS: The sample was primarily female (71.6%), middle-aged (mean age = 56.9 ± 12.1 years), high school educated (62.4%), low-income (72.4% reporting less than $20,000/year income), and received Medicaid (35.9%) or Medicare (12.6%). Mean systolic and diastolic BP were 150.7 ± 16.7 mm Hg and 91.0 ± 10.6 mm Hg, respectively. Participants were prescribed an average of 2.5 ± 1.9 antihypertensive medications; 54.8% were on a diuretic; 33.8% were on a beta blocker; 41.9% were on calcium channel blockers; 64.8% were on angiotensin converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs). One-quarter (25.6%) of the sample had resistant hypertension; one-half (55.7%) reported medication non-adherence. Most (79.7%) reported one or more co-morbid medical conditions. The majority of the patients had a Charlson Co-morbidity score ≥ 2. Diabetes mellitus was common (35.8%), and moderate/severe depression was present in 16% of participants. Participants were sedentary (835.3 ± 1,644.2 Kcal burned per week), obese (59.7%), and had poor global physical health, poor eating habits, high health literacy, and good overall mental health. CONCLUSIONS: A majority of patients in the CAATCH trial exhibited adverse lifestyle behaviors, and had significant medical and psychosocial barriers to adequate BP control. Trial outcomes will shed light on the effectiveness of evidence-based interventions for BP control when implemented in real-world medical settings that serve high numbers of low-income hypertensive African-Americans with multiple co-morbidity and significant barriers to behavior change.

11 Article Daily interpersonal conflict predicts masked hypertension in an urban sample. 2010

Schoenthaler, Antoinette M / Schwartz, Joseph / Cassells, Andrea / Tobin, Jonathan N / Brondolo, Elizabeth. ·Department of Medicine, Center for Healthful Behavior Change, New York University School of Medicine, New York, USA. ·Am J Hypertens · Pubmed #20616788.

ABSTRACT: BACKGROUND: Masked hypertension (MH) is a risk factor for cardiovascular and cerebrovascular diseases. However, little is known about the effect of psychosocial stressors on MH. METHODS: Daily interpersonal conflict was examined as a predictor of elevated ambulatory blood pressure (ABP) in a community sample of 240 unmedicated black and Latino(a) adults (63% women; mean age 36 years) who had optimal office blood pressure (BP) readings (≤120/80 mm Hg). Electronic diaries were used to assess daily interpersonal conflict (i.e., perceptions of being treated unfairly/harassed during social interactions). Participants rated the degree to which they experienced each interaction as unfair or harassing on a scale of 1-100. Systolic and diastolic ABP (SysABP and DiaABP, respectively) were collected using a validated 24-h ABP monitor. Participants were classified as having marked MH (MMH) if the average of all readings obtained yielded SysABP: ≥135 mm Hg or DiaABP: ≥85 mm Hg. Logistic regression was used to examine whether daily interpersonal conflict is an independent predictor of MMH. RESULTS: This form of MMH (i.e., optimal office BP plus elevated ABP) was present in 21% of participants (n = 50). Those with MMH (vs. without) were significantly more likely to be men (P < 0.001). Daily harassment and unfair treatment scores were significant predictors of MMH group status (P < 0.05). Participants with harassment scores >30 were significantly more likely to be in the MMH group. CONCLUSION: MH may be a concern, even for patients with optimal office BP. Evaluating exposure to psychosocial stressors, including routine levels of interpersonal conflict may help to identify those patients who might benefit from further clinical follow-up.