Modifying Lifestyle in Prehypertensive Older Rural Women

描述（由申请人提供）：高血压（HTN）是美国的一个主要健康问题，是心血管疾病（CVD）最普遍的可改变风险因素，心血管疾病是女性的主要杀手。绝经后女性HTN的发病率明显增加，等于或超过男性。血压（BP）的高血压前期类别？收缩压120-139 mm Hg或舒张压80-89 mm Hg -表示个体处于发展HTN的高风险中。高血压前期妇女不适合药物治疗，但需要改变生活方式以防止进展为HTN和CVD。建议的生活方式改变包括采用高水果、蔬菜和低脂乳制品的饮食方法来阻止高血压（DASH）;减少饮食中的钠;定期进行耐力体育活动，辅以阻力运动;超重或肥胖者减轻体重。一些面对面的个人和/或团体干预研究表明，这些生活方式的改变可以降低血压超过6个月的高血压前期个体。仍然需要开发远程分娩方法，以农村妇女为目标，采取类似的行为干预措施，以降低血压。这种竞争性的更新申请将建立在我们目前的工作，我们证明了计算机生成的打印（邮寄）通讯量身定制的健康促进模型（HPM）的结构导致显着的和临床上重要的变化，健康饮食和身体活动的行为和生物标志物在农村中年/老年妇女的一般人群。拟议的随机对照试验将评估互联网与邮寄印刷交付方法提供理论为基础的定制通讯，以鼓励生活方式的改变，降低血压。将275名50-69岁的高血压前期农村妇女按2：2：1的比例随机分配，接受a）通过互联网和简短电话咨询提供的定制信息，B）通过邮件和简短电话咨询提供的定制印刷通讯，或）仅初始标准建议。该项目的主要结果将是在干预期间的6和12个月以及在随访期间的18和24个月时健康饮食，身体活动和血压的变化和标准水平的实现。HPM对特定行为认知/感知影响的变化也将被检查，以验证时事通讯的理论基础。这项研究的结果可能会导致其他人群通过互联网获得更多的生活方式指导。

DESCRIPTION (provided by applicant): Hypertension (HTN), a major health problem in the US, is the most prevalent modifiable risk factor for cardio- vascular disease (CVD), the leading killer of women. The incidence of HTN in women increases markedly after menopause, equaling or exceeding that in men. The prehypertension category of blood pressure (BP)? systolic BP of 120-139 mm Hg or diastolic BP of 80-89 mm Hg - designates individuals at high risk of developing HTN. Prehypertensive women are not candidates for drug therapy, but for lifestyle modifications to prevent progression to HTN and CVD. Recommended lifestyle modifications include adoption of the Dietary Approaches to Stop Hypertension (DASH) diet that is high in fruits, vegetables and low fat dairy products; dietary sodium reduction; regular endurance physical activity supplemented by resistance exercise; and weight reduction by those who are overweight or obese. A few studies of face-to-face individual and/or group interventions have demonstrated that these lifestyle modifications could lower BP over 6 months in pre-hypertensive individuals. There remains a need to develop distance delivery methods to target rural women with similar behavioral interventions to lower BP. This competitive renewal application will build upon our current work in which we demonstrated that computer-generated print (mailed) newsletters tailored to constructs in the Health Promotion Model (HPM) resulted in significant and clinically important changes in behavioral and biomarkers of healthy eating and physical activity in a general population of rural midlife/older women. The proposed randomized controlled trial will evaluate Internet versus mailed print delivery methods for delivering theory-based tailored newsletters to encourage lifestyle change for BP reduction. A sample of 275 prehypertensive rural women aged 50-69 will be randomly assigned 2:2:1 to receive a) tailored messages delivered via the Internet and brief telephone counseling, b) tailored print newsletters delivered via mail and brief telephone counseling, ore) initial standard advice only. The project's primary outcomes will be change in and criterion level achievement for healthy eating, physical activity and blood pressure at 6 & 12 months during the intervention and at 18 & 24 months during follow-up. Change in behavior-specific cognitive/ perceptual influences from the HPM also will be examined to validate the theory base for the newsletters. Results of this study may lead to expanded access to lifestyle guidance via the Internet by other populations.