College of Nursing, Medical University of South Carolina, Charleston, WV 29425, USA.
College of Medicine, Medical University of South Carolina, Charleston, WV 29425, USA.
Int J Environ Res Public Health. 2020 Mar 17;17(6):1955. doi: 10.3390/ijerph17061955.
(1) Background: Hypertension (HTN) affects ~50% of adults and is a major risk factor for stroke and cardiovascular disease. In 2017, the SPRINT trial outcomes led to lowering of HTN cutoffs by the American College of Cardiology (ACC) and American Heart Association (AHA). The Joint National Committee (JNC8) and National High BP Education Program recommend that lifestyle modifications be used as first-line HTN treatment. Chronic stress is a risk factor for HTN and cardiovascular disease. A recently completed 12 month randomized controlled trial (RCT) of a breathing meditation smart phone app (Tension Tamer, TT) involving JNC8 designated pre-HTN adults provided an opportunity to examine its impact upon individuals now classified as having stage 1 HTN. The TT app captures continuous real-time heart rate (HR) from a user's fingertip placed over a video camera lens during sessions. Users receive immediate feedback graphs after each session, showing their HR changes. They also receive motivational and social reinforcement SMS text messages the following day based upon levels of adherence. We conducted ancillary analyses of a 2-arm, 12-month, small-scale efficacy RCT among a subgroup of our total sample of participants, who are now classified as having stage 1 non-medicated systolic HTN. Primary outcome was change in resting systolic blood pressure (SBP). Secondary outcomes were change in resting diastolic blood pressure, adherence to the TT protocol, and perceived stress levels. (2) Methods: 30 adults (mean age: 45.0 years; 15 males; 16 White; 14 Black) with ACC/AHA 2017 defined systolic HTN (130-139 mmHg) on 3 consecutive sessions (mean SBP: 132.6 mmHg) were randomly assigned to TT or lifestyle education program delivered via smartphone (SPCTL). Each group received a twice-daily dosage schedule of TT or walking (month 1: 15 min; months 2 and 3: 10 min; months 4-12: 5 min). (3) Results: Mixed modeling results revealed a significant group x time effect for SBP (p<.01). The TT group showed greater SBP reductions at months 3 (-8.0 vs. -1.9), 6 (-10.0 vs. -0.7), and 12: (-11.6 vs. -0.4 mmHg; all -values <0.04). (4) Conclusion: The TT app was beneficial in reducing SBP levels among adults with stage 1 systolic HTN. The TT app may be a promising, scalable first-line tactic for stage 1 HTN. Preparations are underway for an efficacy RCT involving uncontrolled stage 1 HTN patients.
(1) 背景：高血压（HTN）影响约 50%的成年人，是中风和心血管疾病的主要危险因素。2017 年，SPRINT 试验结果导致美国心脏病学会（ACC）和美国心脏协会（AHA）降低了 HTN 的截止值。联合国家委员会（JNC8）和国家高血压教育计划建议将生活方式改变作为一线 HTN 治疗。慢性应激是 HTN 和心血管疾病的一个危险因素。最近完成的一项涉及 JNC8 指定的前期 HTN 成年人的为期 12 个月的呼吸冥想智能手机应用（Tension Tamer，TT）随机对照试验（RCT）提供了一个机会，来研究其对现在被归类为 1 期 HTN 的个体的影响。TT 应用程序在会话期间从用户放在摄像机镜头上的指尖捕获连续实时心率（HR）。用户在每次会话后立即收到显示其 HR 变化的反馈图。他们还会根据依从性水平在第二天收到激励和社交强化短信。我们对我们总样本中一组参与者进行了一项 2 臂、12 个月、小规模疗效 RCT 的辅助分析，这些参与者现在被归类为患有 1 期非药物治疗的收缩期 HTN。主要结局是静息收缩压（SBP）的变化。次要结局是静息舒张压、TT 方案的依从性和感知压力水平的变化。(2) 方法：30 名成年人（平均年龄：45.0 岁；15 名男性；16 名白人；14 名黑人）在连续 3 次就诊时患有 ACC/AHA 2017 年定义的收缩期 HTN（130-139mmHg）（平均 SBP：132.6mmHg），随机分配至 TT 或通过智能手机提供的生活方式教育计划（SPCTL）。两组均接受 TT 或步行的每日两次剂量方案（第 1 个月：15 分钟；第 2 和第 3 个月：10 分钟；第 4-12 个月：5 分钟）。(3) 结果：混合模型结果显示 SBP 存在显著的组间时间效应（p<.01）。TT 组在第 3、6 和 12 个月时 SBP 降低更明显（分别为-8.0 比-1.9、-10.0 比-0.7 和-11.6 比-0.4mmHg；所有-值均<0.04）。(4) 结论：TT 应用程序有益于降低 1 期收缩期 HTN 成年人的 SBP 水平。TT 应用程序可能是一种有前途的、可扩展的 1 期 HTN 一线策略。正在为涉及未控制的 1 期 HTN 患者的疗效 RCT 做准备。
