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Item Improving blood pressure screening and control in primary care: a quality initiative(Montana State University - Bozeman, College of Nursing, 2023) Gomendi, Wendy Michelle; Chairperson, Graduate Committee: Molly SecorBackground: Hypertension costs the United States healthcare system billions of dollars and accounts for 1 in 6 deaths annually. Management of hypertension is a priority in primary care settings. Strategies to prevent the adverse health effects of hypertension in the United States include increasing awareness of the health risks of uncontrolled hypertension, promoting the use of healthcare teams to manage hypertension, and empowering patients to use self-measured blood pressure monitoring. Local Problem: To address the high rate (58%) of uncontrolled hypertension at a family practice clinic in Montana, a QI project was implemented aimed at improving blood pressure screening, management, and control. Methods: The Knowledge to Action model guided the development of a workflow that incorporated an existing hypertension management policy based on USPSTF hypertension screening and management recommendations. Interventions: Interventions were implemented over four weeks. All patients presenting to the clinic with a blood pressure > or = 140/90 were rescreened at the end of the visit. If the blood pressure remained elevated, the clinic staff was asked to provide an informational packet and ask the patient to obtain home blood pressure measurements or return in 7-14 days for a blood pressure check. Individuals with three elevated blood pressures on three separate occasions were referred to their care team for further hypertensive management. Results: The project goals were not achieved; however, the percentage of hypertensive patients with a blood pressure > or = 140/90 decreased by 4%. Conclusion: The QI initiative resulted in a modest increase in hypertension control for the project site. Although goals were not met, the project provided insight into hypertension management barriers, including time constraints on the providers and staff, patient willingness to engage in serial blood pressure measurements, and readiness of providers and patients to escalate hypertensive medication therapy.Item The impact of trait anxiety and psychosocial stress on sympathetic neural control in humans(Montana State University - Bozeman, College of Letters & Science, 2023) Bigalke, Jeremy Andrew; Chairperson, Graduate Committee: Cara A. Palmer; This is a manuscript style paper that includes co-authored chapters.Anxiety is highly prevalent, and while it is often adaptive, excessive stress and anxiety may predispose individuals to a heightened risk of cardiovascular disease. While excessive activity of the sympathetic nervous system (SNS) may underlie this association, direct measures of muscle sympathetic nerve activity (MSNA) indicate little, if any, alterations in resting sympathetic outflow in individuals with anxiety disorders. Assessment of the relationship between trait anxiety, MSNA, and blood pressure using a large cohort of healthy adults has not yet been conducted. Further, utilization of stress tasks within microneurographic settings that minimize the potential influence of breathing alterations, muscle movement, and other variables on the typically observed inter-individual variability in MSNA responsiveness to mental stress are needed to adequately assess the sole contribution of psychological stress on sympathetic neural activity. In Study 1, the association between trait anxiety, MSNA, and resting blood pressure was assessed in a population of 88 healthy adults, representing the largest study to date pairing trait anxiety with directly recorded sympathetic outflow to the periphery. Our findings indicate an independent relationship between trait anxiety, MSNA, and blood pressure when controlling for both age and sex. In Study 2, we utilized the trier social stress test (TSST) to assess the impact of anticipatory stress on MSNA and blood pressure in 28 healthy adults. Our findings showed that anticipatory stress is associated with increased blood pressure and reduced MSNA. Additionally, this appears to be baroreflex mediated as the magnitude of changes in blood pressure were directly proportional to reductions in MSNA, a relationship that was weakened or nonexistent during the active speech portion of the task. Lastly, anticipatory MSNA responsiveness accurately predicted reactivity to subsequent stress tasks. Together, these studies highlight a key relationship between both chronic, and acute psychological stress and anxiety on sympathoneural function in healthy adults.Item Influence of alpha intrusion during sleep: psychological and physiological implications(Montana State University - Bozeman, College of Letters & Science, 2022) Greenlund, Ian Mark; Chairperson, Graduate Committee: Jason CarterPoor sleep quality is pervasive in developed societies from chronic sleep disturbances or self-imposed sleep curtailment. Sleep disorders like insomnia are associated with regular sleep difficulties including sleep initiation and maintenance. Anxiety and depression exhibit a bidirectional relationship with insomnia, potentially exacerbating poor sleep quality and altering sleep microarchitecture via high frequency electroencephalographic (EEG) intrusion. This includes wake EEG alpha and beta rhythms. An association between high frequency intrusion and psychological dysfunction is present, but little is known regarding alpha and beta frequency intrusion 1) presence with state and trait anxiety symptoms, 2) impact on nocturnal blood pressure regulation, and 3) exacerbation with binge alcohol consumption. In study 1, we examined the relationship between state and trait anxiety severity with alpha and beta intrusion during stage N2 sleep, slow wave sleep (SWS), and rapid eye movement (REM) sleep in 32 participants. We demonstrated that alpha and beta frequency intrusion was augmented in participants with higher state, but not trait anxiety. In study 2, we investigated whether alpha and beta frequency intrusion impacted nocturnal blood pressure regulation in 36 young, healthy adults. Overall, systolic arterial pressure (SAP) dipping and cardiovagal baroreflex sensitivity (cvBRS) were not related alpha and beta spectral power during sleep. In study 3, we explored whether binge alcohol consumption could further exacerbate alpha and beta intrusion during sleep in higher state and trait anxiety participants in 31 participants. A secondary aim of this study was to determine if high frequency spectral power was different between sexes following alcohol consumption. Following laboratory familiarization night (study 2), participants were tested twice, ~1 month apart in a randomized, crossover design consuming either an alcohol dose (study 3) based upon biological sex and body weight, or fluid control beverage (study 1) two hours prior to lights out. Alpha and beta spectral power was not different between lower and higher state and trait anxiety, but was augmented in females compared to age-matched males. Collectively, these studies are the first investigate alpha intrusion presence with state and trait anxiety symptoms, impact on nocturnal blood pressure regulation, and sex specific exacerbation following alcohol consumption.Item Putting the vital in vitality: establishing the link between the phenomenological experience of vitality and patterns of blood pressure in the laboratory and daily life(Montana State University - Bozeman, College of Letters & Science, 2020) Tintzman, Courtney Suzanne; Co-Chairs, Graduate Committee: Neha John-Henderson and Ian M. HandleyHistorically, much attention has been paid to the potentially harmful effects of unhealthy behaviors and poorly regulated emotion on cardiovascular health, but a growing area of research focuses on whether positive psychological states, such as vitality, may also affect cardiovascular risk. Vitality--characterized by feelings of aliveness and energy--has been theorized to reduce risk for development of cardiovascular disease by a) directly regulating biological systems, and indirectly, by regulating negative emotional states that may lead to poor physiological responses. Existing literature focuses on prospective cardiovascular outcomes, but the current studies examine ways in which vitality may relate to cardiovascular health prior to development of cardiovascular disease. The current project extends existing literature by assessing the relationship between vitality and blood pressure, an informative, short-term indicator of cardiovascular health. Two studies hypothesized that vitality would provide more effective regulation of blood pressure in two different contexts. Study I (N = 126) examined the hypothesized relationship between vitality and blood pressure within the context of a laboratory stress paradigm. Vitality was measured upon entrance to the laboratory, and blood pressure was measured before, during, and after a speech task. Following a model proposed by Kuzbansky and Thurston (2007), vitality was hypothesized to directly, and also 'indirectly' through the reduction of cognitive and somatic anxiety about the stress task, predict more highly regulated reactivity and faster recovery from a psychosocial stressor. Results failed to support predictions: vitality did not predict patterns of blood pressure reactivity and recovery to a stressor, directly nor indirectly. Study II (N = 100) utilized ecological momentary assessment to investigate the hypothesized relationship between vitality and blood pressure in daily life. Participants completed daily measures of vitality and perceived stress, and ambulatory blood pressure was captured every four hours. In support of the hypotheses, vitality and perceived stress emerged as a significant predictors of blood pressure across time, suggesting that vitality may directly and indirectly affect blood pressure. These findings add to a growing area of research that suggest vitality as an important factor in cardiovascular health. Limitations and implications for future research are discussed.Item Preeclampsia and increased risk of cardiovascular disease: a practice guide for providers(Montana State University - Bozeman, College of Nursing, 2020) Toole, Brielle Ashli; Chairperson, Graduate Committee: Sandra Benavides-VaelloCardiovascular disease (CVD) is the leading cause of death among women, however this disease is preventable and treatable. Extant evidence has established that women with a history of preeclampsia are at an increased risk for developing CVD later in life, and yet preeclampsia is under-recognized as a risk factor for CVD. This is due to a knowledge gap amongst healthcare providers, and subsequently providers are not adequately educating their patients with a history of preeclampsia about their CVD risk and reducing this risk. There are no specific guidelines regarding long-term care or screening for CVD in women with a history of preeclampsia, so a guideline needs to be developed to assist providers in caring for this high-risk population. The first aim of this project is to develop a guideline for providers to use in practice while caring for women with a history of preeclampsia, and the second aim is to enhance providers' knowledge of the link between a history of preeclampsia and increased CVD risk later in life so they can provide improved, evidence-based care. This project used a pre-survey, educational content with dissemination of two practice guidelines in different formats and a patient educational handout, and post-survey approach. The project targeted healthcare providers who care for women with a history of preeclampsia at a small rural hospital. Providers who participated in this project did have knowledge of the link between preeclampsia and increased CVD later in life, but were not applying this knowledge to their practice, as they neither took a thorough pregnancy history from their patients in regards to preeclampsia nor provided counseling to women with a history of preeclampsia about their increased risk of CVD. Providers who reviewed the guideline presented in this project found it helpful and had or planned to implement a practice change because of the guideline. The practice guideline developed was an effective tool to help the providers in this project implement evidence-based care into their practice, and the patient handout was an additional resource they could use to educate their patients with a history of preeclampsia.