Original Article

Journal of General Internal Medicine

, Volume 22, Issue 6, pp 768-774

Hypertensive Patients’ Race, Health Beliefs, Process of Care, and Medication Adherence

  • Nancy R. KressinAffiliated withCenter for Health Quality, Outcomes and Economic Research (a VA Health Services Research and Development National Center of Excellence), Bedford VA Medical CenterDivision of General Internal Medicine, Boston University School of Medicine Email author 
  • , Fei WangAffiliated withCenter for Health Quality, Outcomes and Economic Research (a VA Health Services Research and Development National Center of Excellence), Bedford VA Medical CenterHealth Policy and Management Department, Boston University School of Public Health
  • , Judith LongAffiliated withCHERP, Philadelphia VAMCDepartment of Internal Medicine, University of Pennsylvania School of Medicine
  • , Barbara G. BokhourAffiliated withCenter for Health Quality, Outcomes and Economic Research (a VA Health Services Research and Development National Center of Excellence), Bedford VA Medical CenterHealth Policy and Management Department, Boston University School of Public Health
  • , Michelle B. OrnerAffiliated withCenter for Health Quality, Outcomes and Economic Research (a VA Health Services Research and Development National Center of Excellence), Bedford VA Medical Center
  • , James RothendlerAffiliated withCenter for Health Quality, Outcomes and Economic Research (a VA Health Services Research and Development National Center of Excellence), Bedford VA Medical CenterHealth Policy and Management Department, Boston University School of Public Health
  • , Christine ClarkAffiliated withJesse Brown VAMCUniversity of Illinois at Chicago
  • , Surekha ReddyAffiliated withJesse Brown VAMCUniversity of Illinois at Chicago
  • , Waldemar KozakAffiliated withCenter for Health Quality, Outcomes and Economic Research (a VA Health Services Research and Development National Center of Excellence), Bedford VA Medical Center
    • , Laura P. KroupaAffiliated withSt. Louis VAMCSt. Louis University
    • , Dan R. BerlowitzAffiliated withCenter for Health Quality, Outcomes and Economic Research (a VA Health Services Research and Development National Center of Excellence), Bedford VA Medical CenterHealth Policy and Management Department, Boston University School of Public Health

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Abstract

BACKGROUND

African Americans have higher rates of hypertension and worse blood pressure (BP) control than Whites, and poorer medication adherence may contribute to this phenomenon. We explored associations among patients’ race, self-reported experiences with clinicians, attitudes and beliefs about hypertension, and ultimately, medication adherence, among a sample with no racial disparities in BP control, to determine what lessons we could learn from patients and providers in this setting.

METHODS

We recruited 793 White and African-American (58%) patients previously diagnosed with hypertension from 3 VA medical centers to participate in survey assessments of each of the above dimensions, subsequent to a primary care clinic visit.

RESULTS

African-American patients’ providers were significantly more active in advising and counseling about hypertension care and medication adherence. African-American patients indicated greater knowledge or heightened awareness of the importance of controlling their BP, but there were no race differences on a summary adherence measure. In multivariate models modeling medication adherence, race was not significant, but having been told to split one’s pills, believing one’s BP continues to be high, and having one’s provider discuss things to do to make it easier to take BP medications were each significantly associated with worse adherence, whereas having more confidence in one’s ability to take BP medications as prescribed was associated with better adherence (all p’s  ≤ .02).

CONCLUSION

When both physicians and patients take BP management seriously, disparities in BP adherence and control may be reduced.

KEY WORDS

physician–patient relations patient compliance attitude to health