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. Kressin
  • 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

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 

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Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Nancy R. Kressin
    • 1
    • 2
  • 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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