Nursing study looks at newsletters’ effect on hypertension

Susan Walker, Ed.D.

UNMC College of Nursing researchers have launched a $1.9 million, five-year study that will examine the effectiveness of tailored newsletters in helping reduce hypertension in women at risk.

The study is funded by the National Institute for Nursing Research, part of the National Institutes of Health (NIH). It will compare tailored newsletters delivered via the Internet and mailed newsletters. Over the course of the study, women will receive 16 newsletters that provide information about approaches to healthy eating and a walking program directed toward reducing blood pressure.

The study will be conducted in women in eight central Nebraska counties: Hall, Buffalo, Sherman, Howard, Merrick, Hamilton, Adams and Kearney.

Hypertension, also referred to as high blood pressure, is a major health problem in the United States and is the most prevalent risk factor for cardiovascular disease, the leading killer of women. It also can lead to stroke and kidney disease. Pre-hypertension is considered blood pressure between normal and high. The incidence of hypertension in women increases markedly after menopause.

“A lot of women don’t know they are pre-hypertensive,” said Susan Walker, Ed.D., principal investigator of the study and UNMC College of Nursing Dorothy Hodges Olson Chair in Nursing. “We hope our study will help promote awareness so women can modify their lifestyle and not become hypertensive.”

The study team includes Dr. Walker, Carol Pullen, Ed.D., professor, UNMC College of Nursing and co-principal investigator, and two other investigators, Patricia Hageman, Ph.D., UNMC School of Allied Health Professions, and Linda Boeckner, Ph.D., University of Nebraska-Lincoln Panhandle Research and Extension Center in Scottsbluff. Part of the study team is based in Grand Island at the Central District Health Department.

Pre-hypertensive women are not candidates for drug therapy, however, lifestyle modifications can prevent hypertension and cardiovascular disease in many women.

Adults are considered pre-hypertensive when their systolic pressure is 120 to 139, or when diastolic pressure is 80 to 89. High blood pressure is a systolic pressure of 140 or higher and/or a diastolic pressure of 90 or higher that remains high over time.

Dr. Walker said a few studies of face-to-face individual and/or group interventions have demonstrated that lifestyle modifications could lower blood pressure over six months in pre-hypertensive individuals. “There remains a need to develop distance delivery methods to target women with similar behavioral interventions to lower blood pressure,” she said.

Researchers are recruiting 275 participants between the ages of 50 and 69 in Grand Island and the surrounding counties in central Nebraska.

Dr. Walker’s team will evaluate three approaches: tailored messages delivered via the Internet combined with telephone counseling; tailored print newsletters sent by ground mail combined with telephone counseling, and one-time advice. Results of the study may lead to expanded access to lifestyle guidance via the Internet by other populations.

Study participants will make visits to Grand Island to receive assessments of blood pressure, activity, diet and cholesterol. In order to qualify, candidates for the study must have access to the computer and able to complete a survey over the computer with minimal assistance. Candidates cannot be taking blood pressure medication. Those who qualify for the study will receive a small stipend.

Study participants will follow the Dietary Approaches to Stop Hypertension, which includes a diet high in fruits, vegetables and low fat dairy products. Women also will be provided information on reducing salt intake, regular endurance physical activity and resistance exercise, and a weight loss program for those who are overweight.

Dr. Pullen said in a previous UNMC study that 56 percent of women in this age group were unknowingly pre-hypertensive.

“We know the incidence of pre-hypertension is high. That’s why we realized there was the need and we want to address this before it becomes a problem,” Dr. Pullen said.

Previous studies suggest a reduction of 5mm (millimeters of mercury) in blood pressure in the U.S. population would result in an estimated 14 percent reduction of stroke and a 9 percent reduction in cardiovascular disease. Estimated costs associated with cardiovascular disease in the United States is $368 billion a year.

Two members of the UNMC study team will be based in Grand Island at the Central District Health Department.

For more information, contact Denise Waibel-Rycek, UNMC College of Nursing Kearney Division, at 308-865-1606 or dwaibelrycek@unmc.edu.