Title: Developing and testing an intervention to support lifestyle change in adults with mild hypertension.
Funder: Department of Health and Social Care

Abstract: Background Hypertension is a key risk factor for cardiovascular and renal disease. Lifestyle modifications can reduce blood pressure and are recommended in most guidelines with or without pharmacological treatment depending on absolute blood pressure and estimated cardiovascular risk. These lifestyle modifications include recommendations on diet, increasing physical activity, smoking cessation and reduction in alcohol consumption. However, studies suggest that implementation in individuals with hypertension is poor and that there are many barriers to change. The NHS Five Year Forward View outlines the rising burden of ill health driven by adverse lifestyle factors and highlights the key role of primary care in addressing this. There is an opportunity to find better ways to support individuals with hypertension make lifestyle modifications to reduce blood pressure and long term cardiovascular risk. Previous studies have evaluated a wide variety of interventions to assist lifestyle modification in individuals with hypertension including one-to-one support, group counselling and peer support. Succesful interventions have been underpinned by behavioural change theory and behavioural change techniques. Many of these have shown significant reductions in blood pressure with multi-component lifestyle modification. However, such programmes are typically complex, likely to be costly to roll out at scale and may not be convenient to patients. Therefore, simple low-cost, effective interventions are needed.There is increasing evidence that internet and mobile-based interventions can support lifestyle modification. Mobile phone-based interventions have proven particularly effective in smoking cessation trials and more recent work has shown promise in reducing markers of cardiovascular risk for secondary prevention. Furthermore, there is also evidence that self-monitoring is an effective intervention in blood pressure reduction, particularly if combined with an additional co-intervention. Combining self-monitoring with a mobile phone-based intervention might therefore be effective in supporting lifestyle change to reduce blood pressure but has not been tested in primary care for treatment nave people with mild hypertension.Aim of the researchThe overall aim of this programme of work is to develop and feasibility test a novel digital intervention including individualized feedback, motivational messaging, self-monitoring of blood pressure, and educational materials aimed at reducing blood pressure in individuals with mild hypertension through lifestyle modification.Overview of MethodsThis will be a mixed methods study underpinned by MRC guidance on the development of complex interventions and including the following:(1)Work Package (WP) 1: Reviewing the evidence: An overview of reviews will characterise individual lifestyle interventions in hypertensive participants and associated reductions in blood pressure. A systematic review will examine internet and mobile phone based interventions used to support lifestyle modification in mild hypertension.(2)Workpackage (WP) 2: Intervention Development: The intervention will be designed and developed utilising modules in use within the Oxford hypertension programme (eg telemonitoring, motivational messaging) based on behavioural change techniques and supported by the Biomedical Engineering Department at the University of Oxford who have expertise in developing health-related technological solutions. It will be iteratively developed with potential users(3)Workpackage (WP) 3: Feasibility study will be conducted to test the intervention developed in WP2 in patients with mild hypertension who have not commenced medication. Potential benefit to the NHSImprovements in lifestyle factors would contribute to lowering of population blood pressure which is predicted to save the NHS over 85 million per year through reduced cardiovascular and renal disease along with associated reductions in medication prescribing costs.Dissemination The findings arising from this work will be disseminated by attendance at scientific conferences and via publication in peer reviewed journals and findings from the feasibility study will be used to inform a large scale randomised trial.

Lay abstract: High blood pressure (or hypertension), if untreated over period of time, increases the risk of developing one of a number of serious conditions including heart attacks, heart disease, stroke and kidney failure. It is possible to reduce blood pressure with medications but it is also possible to reduce blood pressure by making healthy lifestyle changes. These include losing weight, reducing the amount of salt in the diet, increasing exercise and reducing alcohol consumption. However, previous research has shown that many people find it very hard to make healthy lifestyle changes after they have been told that they have high blood pressure. Working with patients, GPs and experts in the field this study plans to investigate whether internet or mobile phone based materials enhanced by regularly measuring one's own blood pressure at home can be used to help people with high blood pressure make healthy lifestyle changes. The planned project will initially search for existing research studies that have looked to answer similar questions and draw together any available answers from these pieces of work. After this has been done, technology experts will provide support to customise already available technology to provide materials for patients that will offer education, motivation and feedback on lifestye changes and the impact of these on blood pressure. This will be designed with regular feedback and important input from patients who may benefit from this technology.Once this support has been developed, I will run a small study to see whether it might be possible undertake a much larger study to determine how effective these materials might be in helping to reduce blood pressure (a so called feasability study). This small scale study will look at several features to help decide if a much larger trial is possible, for example can we recruit enough patients to the study, are we able to follow people up to measure the impact of this support on their blood pressure and are people happy to use the materials that are developed. If this work proves possible, then the findings from a larger study could change significantly how people with high blood pressure are cared for within the NHS.

Research activity codes: 6.3 MEDICAL DEVICES;6.7 PHYSICAL
Health categories: CARDIOVASCULAR