Skip to main content
Log in

High Blood Pressure Medication Adherence Among Urban, African Americans in the Midwest United States

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript


Hypertension is a chronic condition that disproportionately affects African Americans. Managing high blood pressure (HBP) requires adherence to daily medication. However, many patients with hypertension take their HBP medication inconsistently, putting them at heightened risk of heart disease. Researchers have shown that these health risks are greater for African Americans than for Caucasians. In this article, we examine barriers and facilitators of medication adherence among urban African Americans with hypertension. We interviewed 24 African Americans with hypertension (58.5% women, average age 59.5 years) and conducted a comprehensive thematic analysis. Twenty-two barriers and 32 facilitators to medication adherence emerged. Barriers included side effects and forgetting while facilitators included reminders, routines, and social support. Using this data, we developed a diagram of theme connectedness of factors that affect medication adherence. This diagram can guide multi-level HBP intervention research that targets African Americans to promote medication adherence, prevent heart disease, and reduce ethnic and racial health disparities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others


  1. Heron M. Deaths: leading causes for 2016. Natl Vital Stat Rep. 2018;67(6):1–77.

    PubMed  Google Scholar 

  2. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, et al. Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2018;138:e484–594.

    Article  PubMed  Google Scholar 

  3. U.S. Department of Health & Human Services. High blood pressure. 2019; Accessed 29 Apr 2020.

  4. Roberts CK, Barnard RJ. Effects of exercise and diet on chronic disease. J Appl Physiol. 2005;98:3–30.

    Article  PubMed  Google Scholar 

  5. Wu J, Kraja AT, Oberman A, Lewis CE, Ellison RC, Arnett DK, et al. A summary of the effects of antihypertensive medications on measured blood pressure. Am J Hypertens. 2005.

  6. Vrijens B, De Geest S, Hughes DA, Przemyslaw K, Demonceau J, Ruppar T, et al. A new taxonomy for describing and defining adherence to medications. Br J Clin Pharmacol. 2012.

  7. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353:487–97.

    Article  CAS  PubMed  Google Scholar 

  8. Kim MT, Han HR, Hill MN, Rose L, Roary M. Depression, substance use, adherence behaviors, and blood pressure in urban hypertensive black men. Ann Behav Med. 2003.

  9. Schoenthaler A, Ogedegbe G, Allegrante JP. Self-efficacy mediates the relationship between depressive symptoms and medication adherence among hypertensive African Americans. Health Educ Behav. 2009.

  10. Viswanathan H, Lambert BL. An inquiry into medication meanings, illness, medication use, and the transformative potential of chronic illness among African Americans with hypertension. Res Soc Adm Pharm. 2005;1:21–39.

    Article  Google Scholar 

  11. Young JH, Ng D, Ibe C, Weeks K, Brotman DJ, Dy SM, et al. Access to care, treatment ambivalence, medication nonadherence, and long-term mortality among severely hypertensive African Americans: a prospective cohort study. J Clin Hypertens. 2015;17:614–21.

    Article  Google Scholar 

  12. Solomon A, Schoenthaler A, Seixas A, Ogedegbe G, Jean-Louis G, Lai D. Medication routines and adherence among hypertensive African Americans. J Clin Hypertens. 2015;17:668–72.

    Article  Google Scholar 

  13. Flynn SJ, Ameling JM, Hill-Briggs F, Wolff JL, Bone LR, Levine DM, et al. Facilitators and barriers to hypertension self-management in urban African Americans: perspectives of patients and family members. Patient Prefer Adherence. 2013.

  14. Ferdinand KC, Yadav K, Nasser SA, Clayton-Jeter HD, Lewin J, Cryer DR, et al. Disparities in hypertension and cardiovascular disease in blacks: the critical role of medication adherence. J Clin Hypertens. 2017;19:1015–24.

    Article  Google Scholar 

  15. Go AS, Bauman MA, Coleman King SM, Fonarow GC, Lawrence W, Williams KA, et al. An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention. J Am Coll Cardiol. 2014;63:1230–8.

    Article  PubMed  Google Scholar 

  16. Abel WM, Efird JT. The association between trust in health care providers and medication adherence among black women with hypertension. Front Public Health. 2013.

  17. Centers for Disease Control and Prevention. Racial/ethnic disparities in the awareness, treatment, and control of hypertension - United States, 2003–2010. Morb Mortal Wkly Rep. 2013;62(18):351–5.

    Google Scholar 

  18. Yoon SS, Carroll MD, Fryar CD. Hypertension prevalence and control among adults: United States, 2011-2014. NCHS Data Brief. 2015;220:1–8.

    Google Scholar 

  19. Wong MD, Shapiro MF, Boscardin WJ, Ettner SL. Contribution of major diseases to disparities in mortality. N Engl J Med. 2002.

  20. Lackland DT. Racial differences in hypertension: implications for high blood pressure management. Am J Med Sci. 2014;348:135–8.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Hong JC, Padula WV, Hollin IL, Hussain T, Dietz KB, Halbert JP, et al. Care management to reduce disparities and control hypertension in primary care: a cost-effectiveness analysis. Med Care. 2018;56:179–85.

    Article  PubMed  Google Scholar 

  22. White HL. Promoting self-management of hypertension in the African-American church. J Natl Black Nurses Assoc. 2018;29(1):6–12.

    PubMed  Google Scholar 

  23. Victor RG, Lynch K, Li N, Blyler C, Muhammad E, Handler J, et al. A cluster-randomized trial of blood-pressure reduction in black barbershops. N Engl J Med. 2018;378:1291–301.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kling HE, D'Agostino EM, Booth JV, Patel H, Hansen E, Mathew MS, et al. The effect of a park-based physical activity program on cardiovascular, strength, and mobility outcomes among a sample of racially/ethnically diverse adults aged 55 or older. Prev Chronic Dis. 2018;15.

  25. Whelton PK, Einhorn PT, Muntner P, Appel LJ, Cushman WC, Diez Roux AV, et al. Research needs to improve hypertension treatment and control in African Americans. Hypertension. 2016.

  26. Braun V, Clark V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.

    Article  Google Scholar 

  27. Nowell LS, Norris JM, White DE, Moules NJ. Thematic analysis: striving to meet the trustworthiness criteria. Int J Qual Methods. 2017;16:1–13.

    Article  Google Scholar 

  28. Lynch EB, Williams J, Avery E, Crane MM, Lange-Maia B, Tangney C, et al. Partnering with churches to conduct a wide-scale health screening of an urban, segregated community. J Community Health. 2019.

  29. Horne R, Weinman J. Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res. 1999;47:555–67.

    Article  CAS  PubMed  Google Scholar 

  30. Maxwell JA. Using numbers in qualitative research. Qual Inq. 2010;16(6):475–82.

    Article  Google Scholar 

  31. Sandelowski M, Voils CI, Knafl G. On quantitizing. J Mixed Methods Res. 2009;3(3):208–22.

    Article  Google Scholar 

  32. Tolley EE, Ulin PR, Mack N, Robinson ET, Succop SM. Qualitative methods in public health: a field guide for applied research. San Francisco: Wiley; 2016.

    Google Scholar 

  33. U.S. Department of Health and Human Services. Social determinants of health. 2020. Accessed 29 Apr 2020.

  34. Berchick ER, Hood E, Barnett JC. Health insurance coverage in the United States: 2017. United States Census Bureau 2018. Accessed 29 Apr 2020.

  35. Boulware LE, Cooper LA, Ratner LE, LaVeist TA, Powe NR. Race and trust in the health care system. Public Health Rep. 2003.

  36. Hammond WP. Psychosocial correlates of medical mistrust among African American men. Am J Community Psychol. 2010;45:87–106.

    Article  PubMed  PubMed Central  Google Scholar 

  37. LaVeist TA, Nickerson KJ, Bowie JV. Attitudes about racism, medical mistrust, and satisfaction with care among African American and white cardiac patients. Med Care Res Rev. 2000;57:146–61.

    Article  PubMed  Google Scholar 

  38. Hekler EB, Lambert J, Leventhal E, Leventhal H, Jahn E, Contrada RJ. Commonsense illness beliefs, adherence behaviors, and hypertension control among African Americans. J Behav Med. 2008;31:391–400.

    Article  PubMed  Google Scholar 

  39. Lewis LM. Factors associated with medication adherence in hypertensive blacks: a review of the literature. J Cardiovasc Nurs. 2012;27:208–19.

    Article  PubMed  Google Scholar 

Download references


This project was funded by the Irwin W. Steans Center’s Community–based Research Faculty Fellowship at DePaul University.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Daniel J. Schober.

Ethics declarations

University institutional review boards (at Rush University Medical Center and DePaul University) reviewed and approved all study procedures. Participants provided written consent prior to the study.

Conflict of Interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Dr. Ruppar has served as a consultant for Becton Dickinson and The Medicines Company/Novartis.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schober, D.J., Tate, M., Rodriguez, D. et al. High Blood Pressure Medication Adherence Among Urban, African Americans in the Midwest United States. J. Racial and Ethnic Health Disparities 8, 607–617 (2021).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: