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

 描述(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7800多万美国人。与其他种族/民族相比，非裔美国人更有可能患HTN，血压(BP)控制率较低，增加了过早发生心血管疾病和死亡的风险。非裔美国人也更有可能利用急诊科(ED)进行门诊护理，这一因素与HTN患者的不良心血管事件密切相关。ED的高使用率可能反映了获得初级保健的机会很少，并表明人们在自我管理方面面临的挑战。由于血压在急诊室是常规测量的，因此这是识别不受控制的HTN患者和进行干预的理想环境，特别是在非裔美国人社区，那里可能缺乏与医疗保健系统的定期互动。几十年来，改善HTN相关预后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，并遵守处方的降压治疗。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，特别是对居住在城市、资源不足的非裔美国人来说。每天密集的自我监测是有效的，往往是许多行为改变干预措施的基石；然而，长期维持可能很难实现，特别是在居住在资源不足的城市社区的少数群体中。移动健康(MHealth)已经证明在行为改变方面取得了成功，并可能增加长期的自我监控。鉴于手机在少数族裔社区的高普及率，以及对移动互联网接入的更高依赖率，移动健康战略特别适合城市非裔美国人。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得到测试。这项研究旨在改善年龄在25岁到55岁之间患有不受控制的HTN的非裔美国人中与HTN相关的结果，并以三个具体目标为指导。目的1：我们将通过一项随机对照试验(RCT)，与纸质自我监测和常规护理对照，在一年内确定MI-BP(一种综合的、多种健康行为改变的移动干预)对血压控制的效果。目的2：我们将在一年的随机对照试验中，与纸质自我监测和常规护理对照比较，确定MI-BP对二次结局(体力活动、钠摄入量、服药依从性)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.