NURSE-MANAGED BP TELEMONITORING WITH AFRICAN AMERICANS

描述：迫切需要找到更好的控制和治疗方法

DESCRIPTION: There is an urgent need to find better ways to control and treat high blood pressure in African Americans. Although there is some evidence to suggest there may be advantages to home blood pressure (BP) telemonitoring, there is a need for more research since: a) we do not know about the effects of this strategy on long-term control of BP; and b) we do not know the mechanisms by which telemonitoring works to lower BP and achieve BP control. Accordingly, the specific aims of this "new investigator"-led randomized controlled trial are to: a) compare usual care only with home telemonitoring plus usual care to determine which has the greatest effect on change in blood pressure from baseline; and b) determine the extent to which the effects of the intervention are mediated by changes in dietary habits, physical activity level, weight loss, alcohol intake, compliance with an antihypertensive medication regimen, or contact with a primary care provider. Our study is one of the first of its kind using a community-based rather than clinic-based recruitment strategy, thereby expanding access to care. Otherwise healthy African American English speaking men and women (n=400) who are > 18 years with a SBP > 140 mmHG and a DBP > 90 mmHG (unless the individual self-identifies as a diabetic or with a history of a heart attack, then SBP> 130 mmHG, DBP > 85 mmHG) will be conveniently selected from specified community sites. Participants will be randomly assigned to one of two groups that are stratified by use or non-use of antihypertension medication: Group A--home telemonitoring plus usual care; or Group B--usual care only. Participants in Group A will receive usual care plus weekly telemonitoring for 12 months and 15 sessions of telecounseling which provide information about lifestyle modifications in accordance with JNC-VI guidelines. The proposed intervention is intended to increase the saliency of the hypertension for participants, provide a cue to take action and assist them to learn about what actions to take. Data (change in blood pressure from baseline, dietary habits, physical activity level, weight loss, alcohol intake, compliance with an antihypertensive medication regimen, and contact with a primary care provider) will be collected at baseline and at 3, 6 and 12 months. Analysis will include a general mixed linear model approach to repeated measures MANOVA and structural equation growth curve modeling.