Modifying Lifestyle in Prehypertensive Older Rural Women

描述(申请人提供)：高血压(HTN)是美国的一个主要健康问题，是心血管疾病(CVD)最普遍的可改变的危险因素，CVD是女性的头号杀手。绝经后女性HTN的发病率显著增加，与男性持平或超过男性。高血压前期的血压类别(BP)？收缩压为120-139毫米汞柱或舒张压为80-89毫米汞柱--表示患HTN的高危人群。高血压前期女性不适合接受药物治疗，但可以改变生活方式，以防止进展为HTN和CVD。建议的生活方式调整包括采用停止高血压的饮食方法(DASH)，高水果、蔬菜和低脂乳制品的饮食；减少饮食中的钠；定期耐力体育运动辅以抵抗力运动；超重或肥胖者减肥。一些面对面的个人和/或团体干预研究表明，这些生活方式的改变可以在6个月内降低高血压前期患者的血压。仍然需要开发远程分娩方法，以针对农村妇女进行类似的行为干预，以降低血压。这一竞争性续订申请将建立在我们目前的工作基础上，在我们的工作中，我们展示了为健康促进模型(HPM)中的结构量身定做的计算机生成的印刷(邮寄)时事通讯，在农村中年/老年妇女的普通人群中，健康饮食和体力活动的行为和生物标记物发生了重大且具有临床重要性的变化。这项拟议的随机对照试验将评估互联网和邮寄印刷品的投递方法，以提供基于理论的量身定做的新闻通讯，以鼓励改变生活方式来降低血压。275名50-69岁高血压前期农村妇女的样本将被随机分配为2：2：1，接受a)通过互联网和简短的电话咨询发送的定制消息，b)通过邮件和简短的电话咨询发送的定制印刷时事通讯，或)仅接受初始标准建议。该项目的主要结果将是在干预期间6-12个月和随访18-24个月时健康饮食、体力活动和血压的变化和标准水平的实现。还将研究HPM对特定行为的认知/感知影响的变化，以验证时事通讯的理论基础。这项研究的结果可能会导致其他人群通过互联网扩大获得生活方式指导的机会。

DESCRIPTION (provided by applicant): Hypertension (HTN), a major health problem in the US, is the most prevalent modifiable risk factor for cardio- vascular disease (CVD), the leading killer of women. The incidence of HTN in women increases markedly after menopause, equaling or exceeding that in men. The prehypertension category of blood pressure (BP)? systolic BP of 120-139 mm Hg or diastolic BP of 80-89 mm Hg - designates individuals at high risk of developing HTN. Prehypertensive women are not candidates for drug therapy, but for lifestyle modifications to prevent progression to HTN and CVD. Recommended lifestyle modifications include adoption of the Dietary Approaches to Stop Hypertension (DASH) diet that is high in fruits, vegetables and low fat dairy products; dietary sodium reduction; regular endurance physical activity supplemented by resistance exercise; and weight reduction by those who are overweight or obese. A few studies of face-to-face individual and/or group interventions have demonstrated that these lifestyle modifications could lower BP over 6 months in pre-hypertensive individuals. There remains a need to develop distance delivery methods to target rural women with similar behavioral interventions to lower BP. This competitive renewal application will build upon our current work in which we demonstrated that computer-generated print (mailed) newsletters tailored to constructs in the Health Promotion Model (HPM) resulted in significant and clinically important changes in behavioral and biomarkers of healthy eating and physical activity in a general population of rural midlife/older women. The proposed randomized controlled trial will evaluate Internet versus mailed print delivery methods for delivering theory-based tailored newsletters to encourage lifestyle change for BP reduction. A sample of 275 prehypertensive rural women aged 50-69 will be randomly assigned 2:2:1 to receive a) tailored messages delivered via the Internet and brief telephone counseling, b) tailored print newsletters delivered via mail and brief telephone counseling, ore) initial standard advice only. The project's primary outcomes will be change in and criterion level achievement for healthy eating, physical activity and blood pressure at 6 & 12 months during the intervention and at 18 & 24 months during follow-up. Change in behavior-specific cognitive/ perceptual influences from the HPM also will be examined to validate the theory base for the newsletters. Results of this study may lead to expanded access to lifestyle guidance via the Internet by other populations.