MI-BP: mHealth to Improve Blood Pressure Control in Hypertensive African Americans

MI-BP：移动医疗改善非洲裔美国人高血压患者的血压控制

• 批准号: 9271229
• 负责人: Lorraine R Buis
• 金额: $ 75.24万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-06-01 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9271229
• 关键词: Accident and Emergency department; Adherence; Adoption; Affect; African American; Age; Ambulatory Care; American; Antihypertensive Agents; Behavior; Behavioral; Blood Pressure; Car Phone; Cardiovascular system; Cellular Phone; Communities; Dependence; Ethnic Origin; Event; Face; Goals; Health; Health behavior; Health behavior change; Healthcare Systems; Hypertension; Individual; Intake; Internet; Intervention; Intervention Trial; Investigation; Link; Literature; Measures; Mediating; Mediator of activation protein; Minority; Monitor; Morbidity - disease rate; Motivation; Outcome; Paper; Participant; Patients; Pattern; Pharmaceutical Preparations; Physical activity; Physicians; Plant Roots; Population; Primary Health Care; Race; Randomized; Randomized Controlled Trials; Recommendation; Recruitment Activity; Research; Research Personnel; Resources; Risk; Self Blood Pressure Monitoring; Self Care; Self Management; Sodium; Stream; Target Populations; Testing; Time; Traction; Work; arm; base; behavior change; behavioral/social science; blood pressure reduction; blood pressure regulation; cardiovascular risk factor; cohort; cost effective; cost effectiveness; cost-effectiveness evaluation; efficacy testing; experience; health disparity; healthy weight; high risk; improved; mHealth; medication compliance; minority communities; mortality; premature; pressure; programs; public health relevance; secondary analysis; secondary outcome; skills; success; tailored messaging; treatment as usual

 DESCRIPTION (provided by applicant): Hypertension (HTN), one of the most important cardiovascular risk factors, affects more than 78 million Americans. Compared to other races/ethnicities, African Americans are more likely to develop HTN and have lower rates of blood pressure (BP) control, increasing risk of premature cardiovascular morbidity and mortality. African Americans are also more likely to utilize the emergency department (ED) for ambulatory care, a factor strongly linked with adverse cardiovascular events among patients with HTN. This high ED utilization may reflect poor access to primary care, and suggests the challenge people face regarding self-management. Because BP is routinely measured in the ED, it is an ideal setting to both identify patients with uncontrolled HTN and intercede, particularly in African American communities where regular interaction with the health care system may be lacking. Recommendations to improve HTN-related outcomes have been consistent for decades: maintain a healthy weight, reduce daily sodium intake, increase physical activity, and comply with antihypertensive therapy as prescribed. Despite tremendous evidence supporting these recommendations, facilitating the necessary behavior changes in patients with HTN remains a challenge, especially in African Americans who reside in urban, under-resourced settings. Daily intensive self-monitoring is efficacious and is often the cornerstone of many behavior change interventions; however, long-term sustainment can be difficult to achieve, especially in minority populations residing in urban, under-resourced communities. Mobile health (mHealth) has demonstrated success with behavior change, and may increase long-term self- monitoring. Given high cell phone adoption rates in minority communities, and higher rates of reliance on mobile Internet access, mHealth strategies are particularly well suited to urban African American populations. Currently, there exists traction among physicians and patients for mHealth HTN interventions, but such an approach to improve BP in hypertensive patients has not been tested. This study seeks to improve HTN-related outcomes in a cohort of African Americans with uncontrolled HTN between the ages of 25 and 55, and is guided by three specific aims. Aim 1: We will determine the efficacy of MI-BP, a comprehensive, multiple health behavior change mobile intervention, on BP control at one year in a randomized controlled trial (RCT) of the intervention compared to paper-based self- monitoring and usual care controls. Aim 2: We will determine the effect of MI-BP on secondary outcomes (physical activity, sodium intake, medication adherence) compared to paper-based self- monitoring and usual care controls, in a one year RCT. Aim 3: We will evaluate the cost-effectiveness of MI-BP compared to paper-based self-monitoring and usual care controls.

 描述（由申请人提供）：高血压 (HTN) 是最重要的心血管危险因素之一，影响着超过 7800 万美国人。与其他种族/族裔相比，非裔美国人更容易患高血压，且血压 (BP) 控制率较低，从而增加了心血管疾病过早发病和死亡的风险。非裔美国人也更有可能利用急诊科 (ED) 进行门诊护理，这是与高血压患者不良心血管事件密切相关的一个因素。急诊科的高利用率可能反映了初级保健的普及程度较差，并表明人们在自我管理方面面临着挑战。由于急诊室定期测量血压，因此这是识别未受控制的高血压患者并进行调解的理想环境，特别是在可能缺乏与医疗保健系统定期互动的非裔美国人社区。几十年来，改善高血压相关结果的建议一直是一致的：保持健康的体重、减少每日钠摄入量、增加体力活动以及遵守处方抗高血压治疗。尽管有大量证据支持这些建议，但促进高血压患者必要的行为改变仍然是一个挑战，特别是对于居住在城市资源贫乏地区的非裔美国人来说。每日密集的自我监控是有效的，并且通常是许多行为改变干预措施的基石；然而，长期维持可能难以实现，特别是对于居住在资源贫乏的城市社区的少数民族人口而言。移动医疗（mHealth）已在行为改变方面取得了成功，并可能增加长期的自我监控。鉴于少数族裔社区的手机使用率较高，以及对移动互联网接入的依赖程度较高，移动医疗战略特别适合城市非裔美国人。目前，医生和患者对 mHealth 高血压干预措施存在兴趣，但这种改善高血压患者血压的方法尚未经过测试。本研究旨在改善一组年龄在 25 岁至 55 岁之间高血压未受控制的非裔美国人的高血压相关结果，并以三个具体目标为指导。目标 1：我们将通过一项干预措施的随机对照试验 (RCT) 与纸质自我监测和常规护理对照相比，确定 MI-BP（一种全面的、多种健康行为改变移动干预措施）在一年后对血压控制的功效。目标 2：我们将在为期一年的 RCT 中确定 MI-BP 与纸质自我监测和常规护理对照相比，对次要结果（体力活动、钠摄入量、药物依从性）的影响。目标 3：我们将评估 MI-BP 与纸质自我监测和常规护理控制相比的成本效益。