Factors Associated with Self-Management in African Americans with Hypertension

African Americans (AAs) have a higher prevalence of hypertension (HTN) and poorer health outcomes. Effective management of HTN requires pharmacology, low sodium diet (DIET), and increased physical activity (PA). Little is known about self-management of DIET and PA in AAs with HTN. The aim of this study is to examine the influence of factors (systolic blood pressure, co-morbidities, serum potassium and creatinine, education, depression, locus of control (LOC), and social support) on self-management behaviors (DIET, PA). Using a cross-sectional design, AAs with HTN who participated in a recent clinical trial completed instruments to measure the factors. Two multiple linear regression models were used: one including only internal LOC and one with only external LOC. The sample (N = 77) ranged in ages from 55 to 84 (M = 66; SD = 7.68), most were female (n=50; 65%), and had high medication adherence scores (M = 93.8; SD = 9.77). The models explained 28% of the variance in PA (F = 3.361 [8, 68]; p = .003 with depression, serum creatinine, and social support significantly contributing to the internal LOC model and also to the external LOC model (F = 3.378 [8, 68]; p = .003). The same models explained 23% of the variance in adherence to a low sodium diet (F = 2.599 [8, 68]; p = .015) with serum potassium and social support significantly contributing to both models. Findings from this study inform the development of targeted interventions to increase self-management behaviors in AAs with HTN

Rehabilitation Intervention for Individuals With Heart Failure and Fatigue to Reduce Fatigue Impact: A Feasibility Study

Objective: To investigate feasibility of recruitment, tablet use in intervention delivery, and use of self-report outcome measures and to analyze the effect of Energy Conservation plus Problem-Solving Therapy versus Health Education interventions for individuals with heart failure-associated fatigue. Methods: This feasibility study was a block-randomized controlled trial involving 23 adults, blinded to their group assignment, in a rural southern area in the United States. Individuals with heart failure and fatigue received the interventions for 6 weeks through videoconferencing or telephone. Participants were taught to solve their fatigue-related problems using energy conservation strategies and the process of Problem-Solving Therapy or educated about health-related topics. Results: The recruitment rate was 23%. All participants completed the study participation according to their group assignment, except for one participant in the Energy Conservation plus Problem-Solving Therapy group. Participants primarily used the tablet (n=21) rather than the phone (n=2). Self-report errors were noted on Activity Card Sort (n=23). Reported fatigue was significantly lower for both the Energy Conservation plus Problem-Solving Therapy (p=0.03, r=0.49) and Health Education (p=0.004, r=0.64) groups. The Health Education group reported significantly lower fatigue impact (p=0.019, r=0.48). Participation was significantly different in low-physical demand leisure activities (p=0.008; r=0.55) favoring the Energy Conservation plus Problem-Solving Therapy group. Conclusion: The recruitment and delivery of the interventions were feasible. Activity Card Sort may not be appropriate for this study population due to recall bias. The interventions warrant future research to reduce fatigue and decrease participation in sedentary activities (Clinical Trial Registration number: NCT03820674)

An Integrative Review of Physical Activity in Adults with Inflammatory Bowel Disease

Adults with inflammatory bowel disease (IBD) search for self-management strategies to manage their symptoms and improve their quality of life (QOL). Physical activity (PA) is one of the self-management strategies widely adopted by adults with IBD. This integrative review aimed to synthesize the evidence on health outcomes of PA in adults with IBD as well as to identify the barriers to engaging in PA. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), published literature was searched to identify the articles that addressed PA in adults with IBD. Twenty-eight articles met the inclusion criteria. Many of the reviewed studies used the terms of PA and exercise interchangeably. Walking was the most common PA reported in the studies. The findings from the majority of the reviewed studies supported the benefits of moderate-intensity exercise/PA among adults with IBD. The reviewed studies noted the following positive health outcomes of PA: improvement in QOL, mental health, sleep quality, gastrointestinal symptoms, fatigue and cardiorespiratory fitness. More importantly, participation in PA reduced the risk for development of IBD and the risk for future active disease. The findings from the reviewed studies highlighted the following barriers to engage in PA: fatigue, joint pain, abdominal pain, bowel urgency, active disease and depression

A Pilot Study Investigating the Relationship Between Heart Rate Variability and Blood Pressure in Young Adults at Risk for Cardiovascular Disease

BACKGROUND: Cardiovascular disease is one of the leading causes of death globally with hypertension being a primary cause of premature death from this disease process. Individuals with a family history of cardiovascular disease and hypertension are at a greater risk for developing the same sequela. Autonomic cardiac control is important in the level of cardiac function. One intervention that is effective in improving cardiovascular function is heart rate variability biofeedback training. The purpose of our study was to determine the effectiveness of heart rate biofeedback training on HRV and blood pressure in individuals with a family history of cardiovascular disease. METHODS: Thirty-four participants (76.5% female, 22.7 ± 4.3 years) completed a baseline assessment and training using an established short-term HRV protocol followed by two weeks of at-home paced breathing employing a smartphone application. The participants were then reassessed in a biofeedback clinic. RESULTS: The participants physiological measures showed a significant increase in means between pre and post intervention of SDNN (t (32) = 2.177, p =.037) and TP, (t (32) = 2.327 p = .026). Correlation noted a medium effect on diastolic blood pressure and high frequency heart rate variability, F, r = .41, n =33, p < .05. A multiple regression with all predictor variables in the model found no significance with diastolic and systolic blood pressure. CONCLUSIONS: The findings from this pilot study demonstrated that a two-week paced breathing intervention may assist in reducing heart rate and diastolic blood pressure while improving heart rate variability. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40885-021-00185-z

Factors Associated with Self-Management in African Americans with Hypertension

African Americans (AAs) have a higher prevalence of hypertension (HTN) and poorer health outcomes. Effective management of HTN requires pharmacology , low sodium diet (DIET) , and increased physical activity (PA). Little is known about self-management of DIET and PA in AAs with HTN. The aim of this study is to examine the influence of factors (systolic blood pressure , co-morbidities , serum potassium and creatinine , education , depression , locus of control (LOC) , and social support) on self-management behaviors (DIET , PA). Using a cross-sectional design , AAs with HTN who participated in a recent clinical trial completed instruments to measure the factors. Two multiple linear regression models were used: one including only internal LOC and one with only external LOC. The sample (N = 77) ranged in ages from 55 to 84 (M = 66; SD = 7.68) , most were female (n=50; 65%) , and had high medication adherence scores (M = 93.8; SD = 9.77). The models explained 28% of the variance in PA (F = 3.361 [8 , 68]; p = .003 with depression , serum creatinine , and social support significantly contributing to the internal LOC model and also to the external LOC model (F = 3.378 [8 , 68]; p = .003). The same models explained 23% of the variance in adherence to a low sodium diet (F = 2.599 [8 , 68]; p = .015) with serum potassium and social support significantly contributing to both models. Findings from this study inform the development of targeted interventions to increase self-management behaviors in AAs with HTN

Characterizing Frailty Status in the Systolic Blood Pressure Intervention Trial

BACKGROUND: The Systolic Blood Pressure Intervention Trial (SPRINT) is testing whether a lower systolic blood pressure (BP) target of 120mm Hg leads to a reduction in cardiovascular morbidity and mortality among hypertensive, nondiabetic adults. Because there may be detrimental effects of intensive BP control, particularly in older, frail adults, we sought to characterize frailty within SPRINT to address ongoing questions about the ability of large-scale trials to enroll representative samples of noninstitutionalized, community-dwelling, older adults. METHODS: We constructed a 36-item frailty index (FI) in 9,306 SPRINT participants, classifying participants as fit (FI ≤ 0.10), less fit (0.10 < FI ≤ 0.21), or frail (FI > 0.21). Recurrent event models were used to evaluate the association of the FI with the incidence of self-reported falls, injurious falls, and all-cause hospitalizations. RESULTS: The distribution of the FI was comparable with what has been observed in population studies, with 2,570 (27.6%) participants classified as frail. The median FI was 0.18 (interquartile range = 0.14 to 0.24) in participants aged 80 years and older (N = 1,159), similar to the median FI of 0.17 reported for participants in the Hypertension in the Very Elderly Trial. In multivariable analyses, a 1% increase in the FI was associated with increased risk for self-reported falls (hazard ratio [HR] = 1.030), injurious falls (HR = 1.035), and all-cause hospitalizations (HR = 1.038) (all p values < .0001). CONCLUSIONS: Large clinical trials assessing treatments to reduce cardiovascular disease risk, such as SPRINT, can enroll heterogeneous populations of older adults, including the frail elderly, comparable with general population cohorts