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

 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，影响超过7800万美国人。与其他种族/民族相比，非洲裔美国人更有可能发展为HTN，血压（BP）控制率较低，过早心血管发病率和死亡率的风险增加。非裔美国人也更有可能利用急诊科（艾德）进行门诊护理，这是与HTN患者不良心血管事件密切相关的一个因素。这种高艾德利用率可能反映了初级保健的可及性差，并表明人们在自我管理方面面临的挑战。由于血压是在艾德进行常规测量的，因此它是一种理想的环境，可以识别患有不受控制的HTN的患者并进行调解，特别是在非洲裔美国人社区，那里可能缺乏与医疗保健系统的定期互动。几十年来，改善高血压相关结局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，并遵守规定的抗高血压治疗。尽管有大量证据支持这些建议，但促进HTN患者必要的行为改变仍然是一个挑战，特别是居住在城市，资源不足环境中的非洲裔美国人。日常强化自我监测是有效的，往往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，特别是在居住在城市资源不足社区的少数群体中。移动的健康（mHealth）已经证明在行为改变方面是成功的，并且可以增加长期的自我监测。鉴于少数族裔社区的手机采用率较高，对移动的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洲裔美国人。目前，医生和患者之间存在对mHealth HTN干预的牵引力，但这种改善高血压患者血压的方法尚未经过测试。这项研究旨在改善25至55岁之间患有不受控制的HTN的非裔美国人队列中的HTN相关结局，并以三个具体目标为指导。目标1：我们将在一项随机对照试验（RCT）中确定MI-BP（一种综合的、多种健康行为改变移动的干预）与纸质自我监测和常规护理对照相比在1年时对血压控制的疗效。目标二：我们将在一项为期一年的随机对照试验中，与纸质自我监测和常规护理对照相比，确定MI-BP对次要结局（体力活动、钠摄入量、药物依从性）的影响。目的3：我们将评估MI-BP与纸质自我监测和常规护理对照相比的成本效益。

 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.