OPtimizing Technology to Improve Medication Adherence and BP Control (OPTIMA-BP).

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PROJECT SUMMARY Hypertension disparities persist and are particularly worst in African Americans (AA). Suboptimal hypertension self-management, including adherence to medication-taking of antihypertensives remains a major public health concern. Poor adherence to antihypertensive medications is estimated to occur in 43-78% of patients, with approximately 50% discontinuation after a year, and worse in AA. Even more alarming, AA older adults may not be prescribe evidence-based practice treatment regimens known to more efficient in the AA population. There is a critical need for behavioral approaches and long-term self-management strategies that are feasible, replicable, and scalable. Mobile Health (mHealth) technologies (mobile phone applications [app], text, video messaging) are promising tools to facilitate behavioral change and sustain self-management. While reports support using mHealth technologies for the management of chronic diseases have grown, there is limited data specific to AA older adults. Other gaps identified in the literature regarding mHealth technology include the lack of being theoretically driven, the clinical/epidemiologic investigations are primarily conducted outside of the U.S. limiting generalizability, and the lack of evidence on long-term sustainability and impact on clinically relevant health outcomes. This R01 application, OPtimizing Technology to Improve Medication Adherence and BP Control (OPTIMA-BP) is testing a technology-based interventions compared to a wait-listed control (WL) in a prospective, randomized controlled trial (RCT) design. OPTIMA-BP includes evidenced-based strategies, web-based education, and behavioral skills training to use a theoretically driven mHealth medication management app in conjunction with a guideline directed treatment regimen and nurse counseling. The aims of this study are: [1] To test the effects of OPTIMA-BP vs. WL on systolic BP and serum high- density lipoprotein cholesterol (HDL) in AA older adults with hypertension in a prospective, RCT format; and [2] To test if the attitudinal/knowledge mechanisms of self-management (hypertension knowledge, self-efficacy, perceived social support) and proximal behavioral target mechanisms (taking medications to reduce systolic BP, diet, exercise) mediate OPTIMA-BP vs. WL’s impact on the primary and secondary outcomes (systolic BP, diastolic BP, health-related quality of life, serum lipids, and at least 62% of the sample with BP <130/80 mmHg) over a 12-month time period. A secondary aim of this study will assess OPTIMA-BP and WL’s impact on the primary and secondary outcomes while controlling for covariates/contextual variables such as age and gender. A supplemental and complementary feature of this proposal is the qualitative evaluation to confirm self- management barriers and perceived strengths or limitations of the intervention, which will inform future refinements should these RCT findings be positive.