Interactive Program to Prevent Hypertension in Prehypertensive Seniors

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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.