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)。如果不防止这种进展，那些血压在高血压前范围(130毫米汞柱和/或85-89毫米汞)顶端的65岁及以上的人中，有一半将在四年内患上高血压。值得注意的是，全国预防、检测、评估和治疗高血压联合委员会(JNC-7)的第七份报告建议高血压前期患者实施已被证明可以降低血压的生活方式调整：减肥、DASH饮食、减少钠和酒精摄入量，以及定期体育活动。因此，针对高血压前期老年人的需求而量身定做的全面生活方式调整计划将有助于实现JNC-7的S目标。医生和其他医疗保健提供者通常不为非医疗行为改变干预提供有效支持，导致进展为高血压和使用抗高血压药物。然而，拥有电子医疗记录和在线医疗记录库的健康计划和医疗保健组织，如微软HealthVault、谷歌健康和革命健康，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具有独特的地位。预防或延缓高血压应该减少抗高血压药物的中期成本，以及对最初事件和缺血性心脏病和中风的长期残疾和管理的长期护理成本。该项目将为患有高血压前期的老年人开发和测试交互式多媒体(IMM)程序。这项基于互联网的干预将旨在激励人们对自己的血压管理负责。该计划将涉及血压自我监测和JNC-7推荐的五种经过验证的生活方式调整：体重减轻、停止高血压的饮食方法(DASH)、减少钠、体力活动和饮酒。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访谈的概念。该计划将包括血压管理自我评估，以确定用户与高血压相关的最高风险行为以及他们是否准备改变这些行为，并根据阶段定制内容，以激励最有可能采用和/或导致血压下降的行为改变。第一阶段的原型将由血压管理自我评估和钠降低模块组成。完成后，每个单元将包括：(A)关于变革战略的阶段定制信息；(B)阶段定制的励志视频同行表彰；(C)目标设定活动；(D)障碍识别和解决问题活动；以及(E)行动计划活动。第一阶段的评估将使用受试者内设计，以展示在血压管理知识、态度、行为、自我效能和意图改变前的情况。在第二阶段，完整的计划将在互联网上进行更大规模的随机试验并进行评估。公共卫生相关性：65岁以上的美国人中，有一半血压高于130毫米汞柱(收缩压)和/或85-89毫米汞柱(舒张压)，将在四年内患上高血压。全国预防、检测、评估和治疗高血压联合委员会的第七份报告建议高血压前期患者改变生活方式以降低血压：减肥、DASH饮食、减少钠和酒精消耗以及定期体育活动。这个项目将创建和测试一个互动的生活方式调整计划，以满足高血压前期老年人的需求。

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.