Interactive Program to Prevent Hypertension in Prehypertensive Seniors

描述（由申请人提供）：近四分之一（24%）的美国老年人（>60岁）患有高血压前期（SBP 120-139 mm Hg和/或DBP 80-89 mm Hg）。65岁及以上血压处于高血压前期范围（130 mm Hg和/或85-89 mm Hg）的人群中，如果不预防这种进展，有一半将在4年内发展为高血压。值得注意的是，预防，检测，评估和治疗高血压联合国家委员会（JNC-7）的第七次报告建议高血压前期个体实施已被证明可以降低血压的生活方式改变：减轻体重，DASH饮食，减少钠和酒精的消耗，以及定期的体力活动。因此，针对高血压前期老年人的需要制定一个全面的生活方式改变计划将有助于实现JNC-7的目标。医生和其他卫生保健提供者往往不提供有效的支持，非医疗行为改变干预，导致进展为高血压和降压药物的使用。然而，拥有电子病历和在线病历库的健康计划和医疗保健组织，如Microsoft HealthVault，Google Health和Revolution Health，在识别高血压前期老年人并指导他们进行交互式血压干预方面处于独特的地位。预防或延迟高血压应减少抗高血压药物的中期费用和初始事件的长期护理费用以及缺血性心脏病和中风的长期残疾和管理。本计画将发展及测试一个互动式多媒体（IMM）程式，以提供给高血压前期的老人使用。基于互联网的干预措施将旨在激励人们负责他们的血压管理。该计划将解决血压自我监测和JNC-7推荐的五种经过验证的生活方式改变：减轻体重，停止高血压的饮食方法（DASH）饮食，减少钠，体育活动和饮酒。该计划将借鉴健康信念模型，跨理论模型，社会认知理论和动机面试的概念。该计划将包括一个血压管理自我评估，以确定用户的高血压相关行为的风险最高，他们准备改变这些行为和阶段定制的内容，以激励最有可能被采纳的行为变化和/或导致血压下降。第一阶段原型将包括血压管理自我评估和钠减少模块。完成后，每个模块将包括：（a）针对不同阶段的变革战略信息;（B）针对不同阶段的激励性视频同行推荐;（c）目标设定活动;（d）障碍识别和问题解决活动;（e）行动计划活动。I期评价将采用受试者内设计，以证明血压管理知识、态度、行为、自我效能和意图的前后变化。在第二阶段，将在互联网上进行更大规模的随机试验，开发和评估完整的程序。公共卫生相关性：65岁以上血压高于130 mm Hg（收缩压）和/或85-89 mm Hg（舒张压）的美国人中有一半将在四年内发展为高血压。国家预防、检测、评估和治疗高血压联合委员会的第七次报告建议高血压前期个体实施生活方式改变以降低血压：减轻体重，DASH饮食，减少钠和酒精的消耗，以及定期的体育活动。该项目将创建和测试一个针对高血压前期老年人需求的互动式生活方式调整计划。

DESCRIPTION (provided by applicant): Nearly a quarter (24%) of older Americans (>60 yrs) have prehypertension (SBP 120-139 mm Hg and/or DBP 80-89 mm Hg). Half of those 65 years and older with blood pressure in the top of the prehypertensive range (130 mm Hg and/or 85-89 mm Hg) will develop hypertension within four years, if this progression is not prevented. Notably, the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) recommends that prehypertensive individuals implement the lifestyle modifications that have been shown to reduce blood pressure: weight reduction, the DASH diet, reduction in sodium and alcohol consumption, and regular physical activity. Thus, a comprehensive lifestyle modification program that is tailored to the needs of prehypertensive seniors would help meet JNC-7's goals. Physicians and other health care providers often do not provide effective support for non-medical behavior change interventions, resulting in progression to hypertension and the use of antihypertensive medications. However, health plans and healthcare organizations with electronic medical records and online medical record repositories, like Microsoft HealthVault, Google Health, and Revolution Health, are in a unique position to identify prehypertensive seniors and direct them to an interactive blood pressure intervention. Preventing or delaying hypertension should reduce mid-term costs of antihypertensive medications and long-term cost of care for the initial events and long-term disability and management of ischemic heart disease and stroke. This project will develop and test an interactive multimedia (IMM) program for seniors with prehypertension. The Internet-based intervention will be designed to motivate people to take charge of their blood pressure management. The program will address blood pressure self-monitoring and the five proven lifestyle modifications recommended by JNC-7: weight reduction, the Dietary Approaches to Stop Hypertension (DASH) diet, sodium reduction, physical activity, and alcohol consumption. The program will draw from the Health Belief Model, Transtheoretical Model, Social Cognitive Theory, and Motivational Interviewing concepts. The program will include a Blood Pressure Management Self-Assessment to identify users' highest-risk hypertension-related behaviors and their readiness to change those behaviors and stage-tailored content to motivate the behavior changes that are most likely to be adopted and/or result in a drop in blood pressure. The Phase I prototype will consist of the Blood Pressure Management Self-Assessment and the Sodium Reduction module. When complete, each module will include: (a) stage-tailored information on change strategies, (b) stage-tailored motivational video peer testimonials, (c) a goal setting activity, (d) a barrier identification and problem-solving activity, and (e) an action plan activity. The Phase I evaluation will use a within-subject design to demonstrate pre-post change in blood pressure management knowledge, attitudes, behaviors, self-efficacy and intentions. In Phase II, the complete program will be developed and evaluated in a larger randomized trial on the Internet. PUBLIC HEALTH RELEVANCE: Half of Americans 65+ years with blood pressure above 130 mm Hg (systolic) and/or 85-89 mm Hg (diastolic) will develop hypertension within four years. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends that prehypertensive individuals implement lifestyle modifications to reduce blood pressure: weight reduction, the DASH diet, reduction in sodium and alcohol consumption, and regular physical activity. This project will create and test an interactive lifestyle modification program tailored to the needs of prehypertensive seniors.