Self-Management and Resilience Trajectories in African American Adults with Hypertension

项目摘要/摘要： 尽管有大量关于高血压(HTN)的治疗和管理的数据，但生活方式 修改和药物依从性抗高血压药物治疗，自我管理HTN仍然是次优的 在非裔美国人(AA)中，并通过直接的医疗保健对健康结果和患者护理成本产生重大影响 估计每年的支出为429亿美元。自我管理HTN达到血压(BP)目标 &lt；130/80毫米汞柱带来了挑战，如同时使用多种药物和医疗保健提供者， 通过复杂的建议和治疗方案，以及应对负面情绪状态。 在自我保护的背景下，弹性可以是保护健康、福祉和生活质量的重要因素 管理HTN。然而，很少有研究考察生物心理社会 促进再生障碍性贫血患者有效的HTN自我管理和恢复能力的机制。了解 影响HTN自我管理和弹性的机制有望实现新的可修改目标 用于行为改变干预。此R21应用程序、自我管理和恢复能力在 患有高血压的非裔美国人将探索韧性前体对自我管理的影响 行为和压力反应，以及这些联系对健康结果的影响(健康- 相关的生活质量和血压)在6个月内。我们的研究以以下理论基础为指导 格拉斯和麦卡蒂的社会-行为-生物学关系嵌套的分层影响健康和 Szanton和Gill的社会到细胞框架的工作。使用描述性纵向队列设计，我们将 招募125例确诊为HTN伴多种慢性病(MCC)的AA患者作为研究对象。 参与者将接受一系列工具的管理，以获取潜在的协变量、研究变量和 观察基线和3个月和6个月的结果。这项研究的目的是[1]评估这种联系 在韧性前体中(性格乐观和韧性、情绪调节)；应激反应 (皮质醇、白质激素、抑郁认知、感知压力)；HTN自我管理行为和 能力(慢性病管理的自我效能、抗高血压药物的服药依从性)；以及 在基线和3个月和6个月时，患有HTN和MCC的AA患者的健康结局(HQROL，BP)；[2]确定 如果压力反应在弹性前体和健康结果之间的关系中起中介作用，那么当 控制风险监管者；[3]确定自我管理行为是否调节了 在控制风险监管者时，弹性前兆和随时间的健康结果；以及[4]确定 随着时间的推移，影响HTN自我管理行为的弹性轨迹模式和因素。本研究 将通过识别和了解如何进行自我管理和弹性科学 保护性因素和韧性促进自我管理行为并影响个体的健康 为未来旨在降低与次优BP相关的心血管疾病风险的干预性研究提供水平和信息。

PROJECT SUMMARY/ABSTRACT: Although substantial data are available on the treatment and management of hypertension (HTN), lifestyle modification and medication adherence to antihypertensives therapy, self-managing HTN remains suboptimal in African Americans (AA) and has major impacts on health outcomes and patient care cost with direct medical expenditures estimated to cost $42.9 billion annually. Self-managing HTN to a blood pressure (BP) goal of <130/80 mmHg presents challenges such as juggling multiple medications and health care providers, dealing with complex recommendations and treatment regimens, and coping with negative emotional states. Resilience can be an important factor that protects health, well-being, and quality of life in the context of self- managing HTN. However, there has been a paucity of studies that have examined the biopsychosocial mechanisms that foster effective HTN self-management and resilience among AA. Understanding the mechanism that influence HTN self-management and resilience holds the promise of new modifiable targets for behavior change interventions. This R21 application, Self-management and Resilience Trajectories in African Americans with Hypertension, will explore the influence of resilience precursors on self-management behaviors and on stress response, and the effects that these associations have on health outcomes (health- related quality of life and BP) over a 6-month period. Our research is guided by the theoretical underpinnings of both Glass and McAtee’s Society-Behavior-Biology Nexus of nested hierarchical influences on health and the work of Szanton and Gill’s Society-to-Cell framework. Using a descriptive longitudinal cohort design, we will recruit a convenient sample of 125 AA diagnosed with HTN with multiple chronic condition (MCCs). Participants will be administered a battery of instruments to capture potential covariates, study variables, and observe outcomes at baseline and months 3 and 6. The aims of this study are to [1] Assess the association among resilience precursors (dispositional optimism and resilience, emotion regulation); stress response (cortisol, interleukins, depression cognitions, perceived stress); HTN self-management behaviors and capability (self-efficacy for chronic disease mangement, medication adherence to antihypertensives); and health outcomes (HQROL, BP) among AA with HTN and MCCs at baseline and Months 3 and 6; [2] Determine if stress response mediate the relationship between resilience precursors and health outcomes over time when controlling for risk regulators; [3] Determine if self-management behaviors mediate the relationship between resilience precursors and health outcomes over time when controlling for risk regulators; and [4] Identify resilience trajectory patterns and factors that influence HTN self-management behaviors over time. This study will advance self-mangement and resilience science through the identification and understanding of how protective factors and resilience promote self-management behaviors and influence health at the individual level and inform future interventional research intended to reduce CVD risks associated with suboptimal BP.