Andrew Sherwood

My ongoing research focus is on the biological, behavioral, and sociocultural factors involved in the etiology and management of hypertension, coronary artery disease, and congestive heart failure. The role of stress, depression, sedentary lifestyles, and inadequate sleep in disease onset and progression is of central interest.

Specific areas of research include:

• Ethnicity and gender as factors related to the pathogenesis of hypertension
• Mechanisms by which menopause increases the risk of cardiovascular disease in women
• Mechanisms by which stress may provoke episodes of myocardial ischemia in patients with coronary artery disease
• Stress biomarkers that are associated with adverse clinical outcomes in cardiac patients
• Exercise as a behavioral treatment alternative to antidepressant medications for patients with depression
• The mechanisms by which depression is associated with worse clinical outcomes in patients with congestive heart failure
• The development of coping skills interventions to improve prognosis and quality of life in patients with congestive heart failure
• Exercise and weight management intervention for achieving blood pressure control in patients with untreated, treated, and treatment-resistant hypertension
• Circadian blood pressure profiles for risk stratification in patients with hypertension
• Biological and behavioral factors contributing to elevated nighttime blood pressure and blunted nighttime blood pressure dipping
• Inadequate sleep and insomnia disorder as risk factors contributing to the development and exacerbation of cardiovascular disease
• Cognitive behavior therapy for insomnia (CBTi) for the management of patients with cardiovascular disease and comorbid insomnia disorder.
  
  

Psychophysiological assessments include: (i) hemodynamic (blood pressure, cardiac output, systemic vascular resistance) during psychological and physical stress testing; (ii) Sympathetic nervous system (SNS) responses (plasma and urinary epinephrine and norepinephrine) during psychological and physical stress testing; (iv) cardiac and vascular alpha and beta adrenergic receptor sensitivity; (v) the baroreceptor reflex, and cardiac vagal control; (vi) endothelial function measured by ultrasound assessment of flow-mediated dilation of the brachial artery; (vii) vascular structure and compliance measured by pulse wave velocity and ultrasound imaging; (viii) left ventricular structure and function by echocardiography; (ix) 24-hour ambulatory blood pressure and cardiac output monitoring; (x) Noninvasive assessments of arterial stiffness and central aortic pressure; (xi) Psychometric assessments of personality and lifestyle characteristics related to cardiovascular disease; (xii) Assessments of stress, depressive symptoms, and sleep quality by structured interview and self-report; (xiii) Assessments of routine daily physical activity and nighttime sleep quality by 7-day monitoring using 24-hour actigraphy.

Study designs include observational studies, prospective longitudinal studies, and interventional clinical trials, which utilize single-arm trial designs and randomized controlled trials (RCTs).

Interventions include aerobic exercise, with or without dietary weight management, in both structured rehabilitation settings and home-based settings; stress-management training; coping skills training, delivered remotely via synchronous video conferencing or phone calls; and cognitive-behavior therapy for insomnia (CBT-i), delivered remotely via synchronous video conferencing.

The Research Objective is to develop, integrate, and apply biomedical and behavioral knowledge to understand health and disease, and to use this knowledge for prevention, health promotion, diagnosis, treatment, rehabilitation, and care. This research is inherently multidisciplinary, involving collaboration among biomedical, psychological, social, and environmental sciences to elucidate biobehavioral mechanisms and improve clinical and public health outcomes across the disease continuum.

Research Collaborators include, at Duke University, James A. Blumenthal, PhD ( J.P. Gibbons Distinguished Professor Emeritus of Psychiatry and Behavioral Sciences), Jean C. Beckham, PhD (Professor in Psychiatry and Behavioral Sciences and Co-Division Director of Behavioral Medicine and Neurosciences), Robert J. Mentz, MD (Associate Professor of Medicine and Chief, Heart Failure Section) Lana L. Watkins, PhD (Professor Emeritus of Psychiatry and Behavioral Sciences), Christi S. Ulmer, PhD (Associate Professor in Psychiatry and Behavioral Sciences), and at the University of North Carolina (UNC) at Chapel Hill, Alan L. Hinderliter, MD (Henry A. Foscue Distinguished Professor of Medicine; Director, UNC Hospitals Echocardiography Laboratory), Patrick J. Smith, PhD, MPH (Associate Professor of Psychiatry), Gary G. Koch, PhD (Professor of Biostatistics, UNC Gillings School of Global Public Health), Kirkwood Adams, MD (Associate Professor of Medicine and Radiology), and Patricia P. Chang, MD, MHS (Professor of Medicine, and Director, Heart Failure and Transplant Program).