Among blacks with uncontrolled hypertension, this randomized controlled trial will evaluate the impact of a behavioral intervention that combines positive affect and self-affirmation with motivational interviewing on blood pressure control in comparison to a patient education/behavioral contract control group. This study ntitled Trial Using Motivational Interviewing Positive Affect and Self-Affirmation in Hypertension (TRIUMPH) builds upon a preliminary NHLBI funded study conducted by Drs. Carla Boutin Foster and Gbenga Ogedegbe. TRIUMPH is framed upon Social Cognitive Theory and applies positive affect and selfaffirmation induction and motivational interviewing as behavioral strategies. TRIUMPH focuses on hypertension because it is the single most common cause of excess mortality in blacks, accounting for more years of life lost than HIV, diabetes, and homicide. The primary aim is to evaluate whether an intervention that combines positive affect and self-affirmation with motivational interviewing improves blood pressure control compared to an educational/behavioral contract intervention at 12 months. The secondary aims are 1) to evaluate the impact of TRIUMPH on within-patient change in systolic blood pressure (SBP) and withinpatient change diastolic blood pressure (DBF) and 2) to evaluate the impact of TRIUMPH on within-patient change in self-efficacy for medication adherence. This will be a randomized controlled trial conducted among 220 patients recruited from Renaissance Health Network in Central Harlem. The primary outcome is blood pressure control rate at 12 months. Blood pressure(BP) will be assessed with a valid automated digital BP monitor (BPTru) following American Heart Association guidelines. Patients will be categorized as having controlled BP if they have an average BP that fulfills the Seventh Joint National Committee on Detection, Evaluation and Treatment of Hypertension criteria of SBP <130 and DBP <80 mmHg ( for patients with diabetes or chronic kidney disease);or SBP <140 and DBP <90 mmHg (for all other patients). Dr. Boutin- Foster (PI) has assembled experts in biostatistics and epidemiology as co-investigators, including Dr. Ogedegbe a behavioral hypertension specialist. TRIUMPH will address a major public health threat in Central Harlem, where 1 in 3 residents live in poverty and more than 50% have uncontrolled hypertension and provide a model for translating basic behavioral science theories to community interventions.
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