title: Effectiveness of tailored lifestyle interventions, using web-based and print-mail, for reducing blood pressure among rural women with prehypertension: main results of the Wellness for Women: DASHing towards Health clinical trial.
abstract: BACKGROUND
  Lifestyle modification is recommended for management of prehypertension, yet finding effective interventions to reach rural women is a public health challenge. This community-based clinical trial compared the effectiveness of standard advice to two multi-component theory-based tailored interventions, using web-based or print-mailed delivery, in reducing blood pressure among rural women, ages 40-69, with prehypertension.
  
  
  METHODS
  289 women with prehypertension enrolled in the Wellness for Women: DASHing towards Health trial, a 12-month intervention with 12-month follow-up. Women were randomly assigned to groups using a 1:2:2 ratio, comparing standard advice (30-minute counseling session) to two interventions (two 2-hour counseling sessions, 5 phone goal-setting sessions, strength-training video, and 16 tailored newsletters, web-based or print-mailed). Linear mixed model methods were used to test planned pairwise comparisons of marginal mean change in blood pressure, healthy eating and activity, adjusted for age and baseline level. General estimating equations were used to examine the proportion of women achieving normotensive status and meeting health outcome criteria for eating and activity.
  
  
  RESULTS
  Mean blood pressure reduction ranged from 3.8 (SD = 9.8) mm Hg to 8.1 (SD = 10.4) mm Hg. The 24-month estimated marginal proportions of women achieving normotensive status were 47% for web-based, and 39% for both print-mailed and standard advice groups, with no group differences (p = .11 and p = .09, respectively). Web-based and print-mailed groups improved more than standard advice group for waist circumference (p = .017 and p = .016, respectively); % daily calories from fat (p = .018 and p = .030) and saturated fat (p = .049 and p = .013); daily servings of fruit and vegetables (p = .008 and p < .005); and low fat dairy (p < .001 and p = .002). Greater improvements were observed in web-based versus standard advice groups in systolic blood pressure (p = .048) and estimated VO2max (p = .037). Dropout rates were 6% by 6-months, 11.4% by 24 months, with no differences across groups.
  
  
  CONCLUSIONS
  Rural women with prehypertension receiving distance-delivery theory-based lifestyle modifications can achieve a reduction of blood pressure and attainment of normotensive status.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00580528.
authors.affiliation: Physical Therapy Education, School of Allied Health Professions, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, 68198-4420, USA. phageman@unmc.edu.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Hageman
authors.affiliation: College of Nursing, University of Nebraska Medical Center, Omaha, NE, 68198-5330, USA. chpullen@unmc.edu.
authors.forename: Carol H
authors.initials: CH
authors.lastname: Pullen
authors.affiliation: College of Nursing, University of Nebraska Medical Center, Lincoln, NE, 68588-0220, USA. mhertzog@unmc.edu.
authors.forename: Melody
authors.initials: M
authors.lastname: Hertzog
authors.affiliation: Nutrition and Health Sciences, University of Nebraska-Lincoln, Lincoln, NE, 68583-0806, USA. lboeckner1@unl.edu.
authors.forename: Linda S
authors.initials: LS
authors.lastname: Boeckner
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D001823:Body Composition; D003376:Counseling; D002149:Energy Intake; D005247:Feeding Behavior; D005260:Female; D005638:Fruit; D015438:Health Behavior; D006801:Humans; D020407:Internet; D008019:Life Style; D008875:Middle Aged; D009043:Motor Activity; D011177:Postal Service; D058246:Prehypertension / Q000628:therapy*; D012424:Rural Population; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014675:Vegetables
chemical_list: D015415:Biomarkers