Improving Blood Pressure Among African Americans With Hypertension Using a Mobile Health Approach (the MI-BP App): Protocol for a Randomized Controlled Trial.

BACKGROUND African Americans shoulder significant disparities related to hypertension HTN which is a serious public health problem in the city of Detroit Michigan where more than 80 of the population is African American Connectivity through smartphones use of home blood pressure BP monitoring and newly developed mobile health mHealth interventions can facilitate behavioral changes and may improve long term self care for chronic conditions but implementation of a combined approach utilizing these methods has not been tested among African American patients with uncontrolled HTN Since African Americans are more likely than other racial or ethnic subgroups to utilize the emergency department ED for ambulatory care this presents an opportunity to intervene on a population that is otherwise difficult to reach OBJECTIVE The MI BP app aims to reduce health disparities related to HTN in the community by employing a user centered intervention focused on self BP monitoring physical activity reduced sodium intake and medication adherence We seek to test the efficacy of MI BP an mHealth app for HTN self management on BP control primary aim physical activity sodium intake and medication adherence secondary aim in African Americans with HTN This study also seeks to evaluate the cost effectiveness of MI BP when compared with usual care methods METHODS This is a 1 year randomized controlled trial that will recruit individuals who have uncontrolled HTN from 2 EDs in the city of Detroit with a planned sample size of 396 randomized participants To be eligible for inclusion potential participants must be African American 25 to 70 years old previously diagnosed with HTN have a smartphone compatible with MI BP and have uncontrolled BP at triage and on repeat measurement at least 1 hour post triage vitals Once a participant is deemed eligible all study procedures and subsequent follow up visits 8 in total are conducted at the Wayne State University Clinical Research Service Center We seek to determine the effect of MI BP on BP for 1 year using BP control and mean systolic BP as coprimary outcomes and physical activity sodium intake and medication adherence as secondary outcomes compared with usual care controls RESULTS Recruitment for this study began in January 2018 The study will continue through 2021 CONCLUSIONS As the first of its kind conducted in an ED setting MI BP was designed to document the efficacy and acceptability of a multicomponent mHealth approach to help African Americans with uncontrolled BP modify their lifestyle to better manage their HTN We expect to lay the foundation to sustainably reduce HTN related health disparities through better integration of multiple behavior self monitoring and improve outcomes for those who traditionally rely on the ED for chronic disease care TRIAL REGISTRATION ClinicalTrials gov NCT02360293 http clinicaltrials gov ct2 show NCT02360293 INTERNATIONAL REGISTERED REPORT IDENTIFIER IRRID RR1 10 2196 12601