A Just-In-Time Adaptive Mobile Application Intervention To Reduce Sodium Intake And Blood Pressure In Hypertensive Patients

项目总结 膳食钠摄入量过高与高血压和心血管事件有关。相反， 研究表明，较低的钠摄入量既能降低血压，又能预防动脉粥样硬化 心血管疾病(ASCVD)。美国心脏协会指南提倡每天少摄入钠 超过2300毫克，但估计美国人每天的平均钠摄入量为3400毫克。近年来， 预加工食品和餐馆食品的消费量大幅增加，75%以上的钠 现在美国人的平均饮食中来自这些来源。 尽管人们普遍知道高食盐摄入的危害，但这对临床医生来说是一个持续的挑战 正在让患者接受基于生活方式的治疗，以扭转这些趋势，并促进持续的自我 管理和长期坚持低钠饮食。尽管人们越来越希望数字健康 平台可能有助于克服这些问题，但很少有实证研究证明它们的有效性 时间到了。依靠健康行为理论中强大的概念框架，我们最近在早期展示了 基于移动应用的即时适应性干预(JITAI)减少膳食钠摄入量的工作 (R21HS024567)。该JITAI使用地理围栏技术在以下位置提供定制的上下文推送通知 家庭、杂货店和餐馆，在移动设备中链接到基于钠的营养信息 申请。虽然我们的初步结果是令人兴奋的，但仍有待检验的知识的关键差距 1)基于移动应用程序的吉泰专注于降低钠摄入量是否会导致 BP，2)哪些饮食成分调节了干预对BP的影响，以及3)如何优化参与者 参与，以维持饮食和血压的影响随着时间的推移，并防止习惯。 我们研究计划的长期目标是开发成功的基于移动应用的战略， 在适应性技术的推动下，支持患者在常见心血管疾病中的自我管理。 我们的总体目标是评估膳食吉泰钠的降血压效果，建立 改变饮食，调节血压的改善，并优化吉泰，以满足患者的长期参与。我们的 中心假设是，JITAI针对膳食钠的药物将随着时间的推移降低血压，这些影响将是 通过JITAI的优化，更好地维持。因此，我们将执行两个步骤的顺序， 在400名HTN患者中进行的前瞻性随机对照试验，以满足我们的总体目标。在第一步，我们 将调查吉泰对血压的影响，并进行微随机试验，以优化吉泰治疗 耐心参与。第二步，我们将研究优化后的吉泰对BP的持续影响。

PROJECT SUMMARY High dietary sodium intake is linked to incident hypertension (HTN) and cardiovascular events. Conversely, lower sodium intake has been shown to reduce both blood pressure (BP) and prevent atherosclerotic cardiovascular diseases (ASCVD). American Heart Association guidelines advocate daily sodium intake of less than 2,300 mg, but the estimated average sodium intake for Americans is 3,400 mg per day. In recent years, consumption of pre-processed and restaurant foods has substantially increased, and more than 75% of sodium in the average U.S. diet now comes from these sources. Despite widespread knowledge of the harms of high dietary sodium intake, an ongoing challenge for clinicians is engaging patients in lifestyle-based treatments to reverse these trends as well as promote ongoing self- management and long-term adherence to low sodium diets. Although there is growing hope that digital health platforms may help to overcome these issues, few empirical studies have demonstrated their efficacy over time. Relying on a strong conceptual framework in health behavior theory, we recently demonstrated in early work that a mobile application-based just-in-time adaptive intervention (JITAI) reduces dietary sodium intake (R21HS024567). This JITAI uses geofencing technology to provide tailored and contextual push notifications at home, grocery stores, and restaurants with links to sodium-based nutrition information within the mobile application. While our preliminary results were exciting, the critical gaps in knowledge that remain to be tested are 1) whether a mobile application-based JITAI focused on lowering sodium intake will lead to a decrease in BP, 2) which dietary components mediate the intervention's effect on BP, and 3) how to optimize participant engagement to sustain both dietary and BP effects over time and prevent habituation. The long-term goal of our research program is to develop successful mobile application-based strategies, driven by adaptive technologies, that support patient self-management in common cardiovascular conditions. Our overall objectives are to evaluate the efficacy of a dietary sodium JITAI on reducing BP, establish the changes in diet that mediate improvement in BP, and optimize the JITAI for long-term patient engagement. Our central hypothesis is that JITAIs targeting dietary sodium will reduce BP over time and that these effects will be better sustained through optimization of JITAIs. Accordingly, we will perform a two-step sequential, prospective, randomized controlled trial in 400 HTN patients to meet our overall objectives. In the first step, we will investigate the effect of the JITAI on BP and perform a micro-randomized trial to optimize the JITAI for patient engagement. In the second step, we will study the sustained effects of an optimized JITAI on BP.