In the United States, hypertension (HTN) is the leading risk factor for cardiovascular disease and a more significant problem among Black women. About 46.1% of Black women over the age of 20 have HTN compared to White (30.1%) and Hispanic (29.9%) women. Currently, the prevalence of HTN in Black women is highest in the United States and is expected to increase underscoring the relatively ineffective prevention and management efforts for blood pressure (BP) control. Blacks tend to develop HTN earlier in life with greater severity and more organ damage when compared to Whites and uncontrolled HTN increases the risk of heart failure, myocardial infarction, stoke, and kidney disease. Black females experience a substantially higher death rate from HTN at 2.1 times the rate of both White and Hispanic females. Poor execution of evidence-based HTN guidelines and clinical inertia among healthcare providers along with patient nonadherence to prescribed treatment contribute to poor BP control. It is well known that antihypertensive medications along with lifestyle modifications have proven efficacy in lowering BP when adhered to consistently. However, for Blacks, the lingering effects of their historical legacy, continued segregated communities, high poverty rates, and unequal medical treatment, place them in a unique position to view healthcare with skepticism that differs from all other racial/ethnic groups. Thus, accepted approaches to HTN management have not been optimally effective in producing sustained BP control for Black women. Since nonadherence occurs in the context of everyday living, strategies are needed that encourage more active individual engagement in health care behaviors and self- care activities, in the physical and social environment where they can be performed by patients independently. The objective of this NHLBI K01 Mentored Career Development Award is to obtain research training and develop the skills needed to be an independent investigator, and to use those skills to test the effectiveness of an established Chronic Disease Self-management Program (CDSMP) plus an innovative interactive technology-enhanced coaching (ITEC) system, on improving BP control in community-dwelling Black women with uncontrolled HTN. The proposed project is a two-arm randomized controlled trial (RCT), repeated measures design, with specific aims to determine whether the effects of CDSMP combined with ITEC will maintain BP control, attain medication adherence, and achieve lifestyle modifications (medication adherence, physical activity, diet, and weight management) compared to the CDSMP alone. We hypothesize that participants who receive self-care management and interactive coaching with technology will have lower systolic/diastolic BP and better adherence to antihypertensive medication(s) and lifestyle recommendations post intervention compared to participants receiving self-care management alone. The expected outcome of this study will provide preliminary evidence to inform the design of a fully powered RCT for an R01 application before the end of the K Award.
Hypertension is a global problem affecting 972 million adults and an important public health burden since it is the main cause of cardiovascular disease and death, and the second leading cause of disability. Disproportionately affected, Black women have the highest prevalence of hypertension in the United States. This research will evaluate potential interventions for possible community-based strategies for controlling hypertension using interactive self-care strategies with coaching and technology.
