Nearly 1 in 5 young adults (18-39 year-olds) has hypertension, increasing their risk of heart failure, stroke, and chronic kidney disease. Yet, only 35% of hypertensive young adults achieve control. Young adults have a longer exposure to hypertension and a greater lifetime risk for cardiovascular disease. Self-management programs targeted to adults ?50 years old effectively reduce blood pressure (primarily through a focus on medication adherence). However, these programs do not address barriers specific to young adults such as frequent healthcare and vocational transitions, new life responsibilities, and less interest in health-related goals. A primary focus on treatment with medication is not enough to manage blood pressure in young adults. Additional hypertension self-management (defined as home blood pressure monitoring and intensive lifestyle modification) is necessary to achieve and maintain lower blood pressures in young adults over their lifetimes. To address this major gap in hypertensive care, MyHEART (My Hypertension Education And Reaching Target program), a team-based hypertension self-management intervention, was informed and piloted by young adults, providers, and healthcare administrators. MyHEART includes four evidence-based self-management components: 1) telephone-based health coaching with adult education specialists to teach and monitor self- management skills, 2) electronic health record documentation of coach-patient telephone contacts, 3) individualized hypertension education materials, and 4) home blood pressure monitoring. This feasible, innovative proposal targets young adults with uncomplicated and complicated hypertension (hypertension with diabetes and/or chronic kidney disease) and differs from previous studies by targeting barriers specific to young adults. MyHEART directly addresses NHLBI's Strategic Priority 3.1.a: ?Develop and evaluate new approaches to implement proven preventive and lifestyle interventions.? The long-term goal is to disseminate effective interventions to improve hypertension control for young adults. This 5-year proposal is a randomized controlled trial in two large healthcare systems (Madison and Milwaukee, WI) to evaluate MyHEART's impact on blood pressure among 310 geographically and racially/ethnically diverse young adults. Our co-primary outcome is a change in systolic and diastolic blood pressure after 6 and 12 months in young adults (18-39 year-olds) with uncontrolled hypertension. The primary hypothesis is that the implementation of MyHEART will significantly decrease clinic and 24-hour ambulatory blood pressures and increase hypertension self-management, compared to usual clinical care. To ensure successful completion of this proposal, a multi-disciplinary team has piloted MyHEART and established strong multi- institutional support through the Wisconsin Network for Health Research. The results of this study will address an unmet need to develop evidence-based interventions that improve hypertension control in young adults.

Public Health Relevance

This proposal directly addresses the public health burden of uncontrolled hypertension among young adults (18-39 year-olds) that increases their risk for heart disease, stroke, and chronic kidney disease. Although hypertension self-management (home blood pressure monitoring and lifestyle modifications) is recommended to lower and control blood pressure, current hypertension self-management programs do not meet the needs and barriers specific to young adults. This proposal will study the effectiveness of MyHEART, a young adult hypertension self-management program, on lowering systolic and diastolic blood pressure after 6 months and 12 months, compared to usual care.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Special Emphasis Panel (ZHL1)
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Einhorn, Paula T
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University of Wisconsin Madison
Internal Medicine/Medicine
Schools of Medicine
United States
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