Journal of General Internal Medicine

, Volume 22, Issue 6, pp 768–774 | Cite as

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

  • Nancy R. KressinEmail author
  • Fei Wang
  • Judith Long
  • Barbara G. Bokhour
  • Michelle B. Orner
  • James Rothendler
  • Christine Clark
  • Surekha Reddy
  • Waldemar Kozak
  • Laura P. Kroupa
  • Dan R. Berlowitz
Original Article



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.


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.


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).


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


physician–patient relations patient compliance attitude to health 



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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Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Nancy R. Kressin
    • 1
    • 2
    Email author
  • Fei Wang
    • 1
    • 3
  • Judith Long
    • 4
    • 5
  • Barbara G. Bokhour
    • 1
    • 3
  • Michelle B. Orner
    • 1
  • James Rothendler
    • 1
    • 3
  • Christine Clark
    • 6
    • 7
  • Surekha Reddy
    • 6
    • 7
  • Waldemar Kozak
    • 1
  • Laura P. Kroupa
    • 8
    • 9
  • Dan R. Berlowitz
    • 1
    • 3
  1. 1.Center for Health Quality, Outcomes and Economic Research (a VA Health Services Research and Development National Center of Excellence)Bedford VA Medical CenterBedfordUSA
  2. 2.Division of General Internal MedicineBoston University School of MedicineBostonUSA
  3. 3.Health Policy and Management DepartmentBoston University School of Public HealthBostonUSA
  4. 4.CHERPPhiladelphia VAMCPhiladelphiaUSA
  5. 5.Department of Internal MedicineUniversity of Pennsylvania School of MedicinePhiladelphiaUSA
  6. 6.Jesse Brown VAMCChicagoUSA
  7. 7.University of Illinois at ChicagoChicagoUSA
  8. 8.St. Louis VAMCSt. LouisUSA
  9. 9.St. Louis UniversitySt. LouisUSA

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