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

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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.

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Acknowledgments

This research was presented as a poster at the American Heart Association Compliance Conference, May 2005 (NR Kressin, MB Orner, F Wang, J Long, W Kozak, C Clark, S Reddy, L Kroupa, B Bokhour, J Rothendler, D Berlowitz. Racial Differences in Antihypertensive Medication Adherence, Attitudes, Beliefs and Experiences with Blood Pressure Care). This research was supported by grants from the Department of Veterans Affairs (VA) Health Services Research and Development Service (TRH01-038, N. Kressin, P.I). Dr. Kressin is a Research Career Scientist, Department of Veterans Affairs, Health Services Research & Development (RCS 02-066-1); Dr. Long was an Associate in the Career Development Award Program of the VA HSR&D Service when this work was performed (CDA # 00-023).

Conflict of Interest

No authors have any affiliation, financial agreement, or other involvement with any company whose product figured prominently in the submitted manuscript.

The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

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Authors and Affiliations

  1. Center for Health Quality, Outcomes and Economic Research (a VA Health Services Research and Development National Center of Excellence), Bedford VA Medical Center, Bedford, MA, USA

    Nancy R. Kressin PhD, Fei Wang PhD, Barbara G. Bokhour PhD, Michelle B. Orner MPH, James Rothendler MD, Waldemar Kozak MPH & Dan R. Berlowitz MD, MPH

  2. Division of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA

    Nancy R. Kressin PhD

  3. Health Policy and Management Department, Boston University School of Public Health, Boston, MA, USA

    Fei Wang PhD, Barbara G. Bokhour PhD, James Rothendler MD & Dan R. Berlowitz MD, MPH

  4. CHERP, Philadelphia VAMC, Philadelphia, PA, USA

    Judith Long MD

  5. Department of Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Judith Long MD

  6. Jesse Brown VAMC, Chicago, IL, USA

    Christine Clark PharmD & Surekha Reddy MD

  7. University of Illinois at Chicago, Chicago, IL, USA

    Christine Clark PharmD & Surekha Reddy MD

  8. St. Louis VAMC, St. Louis, MO, USA

    Laura P. Kroupa MD

  9. St. Louis University, St. Louis, MO, USA

    Laura P. Kroupa MD

Authors
  1. Nancy R. Kressin PhD
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  2. Fei Wang PhD
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  3. Judith Long MD
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  4. Barbara G. Bokhour PhD
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  5. Michelle B. Orner MPH
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  6. James Rothendler MD
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  7. Christine Clark PharmD
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  8. Surekha Reddy MD
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  9. Waldemar Kozak MPH
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  10. Laura P. Kroupa MD
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  11. Dan R. Berlowitz MD, MPH
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Corresponding author

Correspondence to Nancy R. Kressin PhD.

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Kressin, N.R., Wang, F., Long, J. et al. Hypertensive Patients’ Race, Health Beliefs, Process of Care, and Medication Adherence. J GEN INTERN MED 22, 768–774 (2007). https://doi.org/10.1007/s11606-007-0165-9

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  • DOI: https://doi.org/10.1007/s11606-007-0165-9

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