Minding GOALS: An Internet-Assisted Mind-Body-Behavior Program for Blood Pressure Control

July 3, 2018 updated by: Natalia Morone, University of Pittsburgh

An Internet-Assisted Mind-Body-Behavior Program for Blood Pressure Control

This pilot study will evaluate the feasibility of adding an online mind-body-behavior program to an existing behavioral self-management support platform that has been modified to promote achievement of blood pressure goals.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

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 solution to patient non-adherence to lifestyle recommendations. Health information technology provides a way to make self-management support affordable, convenient and feasible. The investigators 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, the investigators propose to add an online mind-body-behavior program to GOALS: "Minding GOALS." The investigators 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 a randomized clinical trial comparing the online tool to online traditional self-management support, the investigators 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 the proposed measurement protocols.

Study Type

Interventional

Enrollment (Actual)

76

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Pennsylvania
      • Pittsburgh, Pennsylvania, United States, 15213
        • Center for Research on Health Care, University of Pittsburgh

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

21 years to 79 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Systolic blood pressure >/= 150 mmHg and/or
  • Diastolic blood pressure >/= 90 mmHg and
  • At least one other cardiovascular disease (CVD) risk factor (i.e., diabetes, dyslipidemia, family history of premature CVD, current smoking, obesity)

Exclusion Criteria:

  • Known secondary hypertension of any etiology, malignant hypertension or hypertensive encephalopathy
  • Severe edema
  • A primary care physician (PCP) of the opinion that the patient is unable to safely undertake moderately intense unsupervised physical activity (equivalent of 30 minutes brisk walking)
  • A PCP of the opinion that the patient has inadequate cognitive function to participate
  • Previous participation in a mindfulness meditation program
  • An inability to learn adequately from English language materials
  • Current pregnancy or planned pregnancy within the next year
  • A prior diagnosis of post-traumatic stress disorder
  • Prior use of GOALS

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: GOALS
Participants will use for approximately four months an online platform, GOALS, consisting of weekly lessons designed to enhance blood pressure control. Recommended lifestyle changes for hypertension, including a low-sodium diet, physical activity, weight loss (if appropriate) and behavioral self-management skills will be offered. Attention to medication adherence and pharmacist support as well as that of a dedicated online health coach and ongoing collaboration with the primary care physician are also provided.
Behavioral: GOALS
16 weeks of online support to improve blood pressure using traditional behavioral lifestyle approaches and medication adherence support.
Experimental: Minding GOALS
Participants in this arm will also use the GOALS standard tools for blood pressure control. To further maximize success, they will receive additional online behavioral training throughout the 4-month intervention that focuses on mind-body approaches. Weekly topics, for example, will include meditation lessons, mindfulness-based stress reduction and mindfulness-based eating awareness.
Behavioral: GOALS
16 weeks of online support to improve blood pressure using traditional behavioral lifestyle approaches and medication adherence support.
Behavioral: Minding GOALS
16 weeks of online support to improve blood pressure using traditional behavioral lifestyle approaches and medication adherence support, coupled with a mind-body-behavior program to further enhance improvements in blood pressure.
Other Names:
  • Stress reduction

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in systolic blood pressure and diastolic blood pressure (mm Hg)
Time Frame: Baseline, 4- and 12-months
Change in blood pressure
Baseline, 4- and 12-months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in sodium excretion (mmol/24 hr.)
Time Frame: Baseline and 12-months
From 24-hr urine collection
Baseline and 12-months
Body weight (kg)
Time Frame: Baseline, 4- and 12-months
Baseline, 4- and 12-months
Body Mass Index (kg/m2)
Time Frame: Baseline, 4- and 12-months
Baseline, 4- and 12-months
Physical activity (steps/day)
Time Frame: Baseline, 4- and 12-months
Assessed by pedometer
Baseline, 4- and 12-months
Health-related quality of life
Time Frame: Baseline, 4- and 12-months
PROMIS (Patient Reported Outcomes Measurement Information System)-29 Profile v2.0
Baseline, 4- and 12-months
Perceived Stress Scale
Time Frame: Baseline, 4- and 12-months
Baseline, 4- and 12-months
PROMIS-29 Profile v2.0
Time Frame: Baseline, 4- and 12-months
Quality of Life
Baseline, 4- and 12-months
Mindful Attention Awareness Scale
Time Frame: Baseline, 4- and 12-months
Assesses a core characteristic of dispositional mindfulness, namely, open or receptive awareness of and attention to what is taking place in the present
Baseline, 4- and 12-months
Self-reported medication adherence questions
Time Frame: Baseline, 4- and 12-months
Self-reported scale to measure medication adherence
Baseline, 4- and 12-months
Credibility/Expectancy Questionnaire
Time Frame: Baseline, 4- and 12-months
For measuring treatment expectancy and rationale credibility in clinical trials
Baseline, 4- and 12-months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Pittsburgh

Collaborators

National Heart, Lung, and Blood Institute (NHLBI)

Investigators

  • Principal Investigator: Natalia Morone, MD, MS, University of Pittsburgh
  • Principal Investigator: Kathleen M McTigue, MD, MS, MPH, University of Pittsburgh

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

September 1, 2016

Primary Completion (Actual)

March 31, 2018

Study Completion (Actual)

March 31, 2018

Study Registration Dates

First Submitted

January 12, 2016

First Submitted That Met QC Criteria

February 23, 2016

First Posted (Estimate)

February 29, 2016

Study Record Updates

Last Update Posted (Actual)

July 6, 2018

Last Update Submitted That Met QC Criteria

July 3, 2018

Last Verified

July 1, 2018

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • PRO15120045
  • R34HL123500-01 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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