Efficacious hypertension therapies are well-documented, yet 40% of treated patients do not meet the blood pressure goals set by the Joint National Committee. This gap between scientific evidence and clinical outcomes in part reflects low patient adherence to lifestyle recommendations (e.g., physical activity, weight and diet), as well as medication non-adherence. Accordingly, growing attention is focused on the need to provide patients with effective self-management support tools. In addition to finding ways to help patients adhere to currently prescribed hypertension care, it is useful to consider the range of treatment options that are offered. Evidence- based reviews have identified stress reduction as an effective tool for reducing blood pressure, yet such approaches are typically not implemented in practice. This omission represents a chance to improve the quality of hypertension care by adding stress management self-management tools. Furthermore, since patients have demonstrated a clear interest in mindfulness, the incorporation of a holistic mind-body intervention is an innovative approach to inherently patient-centered care. Increasing data supports the use of mindfulness for treating health concerns. Its holistic nature may be particularly well-suited to developing and maintaining healthy lifestyles, since lifestyle impacts diverse aspects of physical and psychological health. Yet the potential for mindfulness in health self-management has not been realized. Limited but promising data demonstrate the effectiveness of web-based counseling for behavior modification to improve common chronic disease risk factors. It is an ideal solution to provider time constraints and a potential solutionto patient non-adherence to lifestyle recommendations. Health information technology provides a way to make self-management support affordable, convenient and feasible. We have developed a convenient behavioral self-management support platform, Goal-oriented Online Access to Lifestyle Support (GOALS) for primary care patients, which has promoted weight loss and improved blood pressure control among primary care patients with weight-related cardiovascular risk factors. To maximize the ability of patients to achieve blood pressure goals, we propose to add an online mind-body-behavior program to GOALS: Minding GOALS. We will evaluate the feasibility of using this program for self-management support in coordination with primary care, in a group of 76 patients with uncontrolled hypertension. In preparation for an RCT comparing the online tool to online traditional self-management support, we will assess implementation and determine 1) the availability of eligible and willing subjects using the proposed recruitment methods, 2) the feasibility of delivering the proposed interventions in the population of interest, and 3) the viability of our proposed measurement protocols. We will modify study protocols as needed, identifying and correcting problems, to strengthen the design of the future RCT and help ensure that it contributes meaningfully to the advancement of patient-centered hypertension self-management support.

Public Health Relevance

Better self-management tools are needed to help adults with high blood pressure manage this common and serious health problem. Many patients with hypertension are interested in mind- body medicine, but it is rarely included in blood pressure treatment - even though studies have shown that stress management can lower blood pressure and mind-body methods can affect lifestyle change. We propose to pilot test two online tools for supporting patients in hypertension management: 1) an online adaptation of traditional blood pressure management supports, including personalized coaching, online lessons on healthy lifestyles and medication use, blood pressure and lifestyle tracking, and graphic feedback, and 2) the same online tools, along with a unique online mindfulness program to help patients reduce stress and take a holistic mindful approach to lifestyle.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Planning Grant (R34)
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Clinical Trials Review Committee (CLTR)
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Stoney, Catherine
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University of Pittsburgh
Internal Medicine/Medicine
Schools of Medicine
United States
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