A 41-Year-Old African American Man With Poorly Controlled Hypertension: Review of Patient and Physician Factors Related to Hypertension Treatment Adherence

Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 04/2009; 301(12):1260-72. DOI: 10.1001/jama.2009.358
Source: PubMed


Mr R is an African American man with a long history of poorly controlled hypertension and difficulties with adherence to recommended treatments. Despite serious complications such as hypertensive emergency requiring hospitalization and awareness of the seriousness of his illness, Mr R says at times he has ignored his high blood pressure and his physicians' recommendations. African Americans are disproportionately affected by hypertension and its complications. Although most pharmacological and dietary therapies for hypertension are similarly efficacious for African Americans and whites, disparities in hypertension treatment persist. Like many patients, Mr R faces several barriers to effective blood pressure control: societal, health system, individual, and interactions with health professionals. Moreover, evidence indicates that patients' cognitive, affective, and attitudinal factors and the patient-physician relationship play critical roles in improving outcomes and reducing racial disparities in hypertension control.

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Available from: Lisa A Cooper, Nov 21, 2014
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    • "African Americans are also more likely to suffer end organ damage as a result of hypertension, including up to four-fold greater rates of kidney failure [5]. Mechanisms for lower rates of treatment adherence for hypertension control among African Americans have not been completely elucidated, but may be due to differential rates of health insurance coverage, less access to health care and resources needed to care for hypertension, and attitudinal differences [6] [7]. Hypertension self-management behaviors including blood pressure self-monitoring, lifestyle changes (e.g., eating and exercise habits), adherence to medications, and shared medical decision-making (i.e. "
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    ABSTRACT: Background: Given their high rates of uncontrolled blood pressure, urban African Americans comprise a particularly vulnerable subgroup of persons with hypertension. Substantial evidence has demonstrated the important role of family and community support in improving patients' management of a variety of chronic illnesses. However, studies of multi-level interventions designed specifically to improve urban African American patients' blood pressure self-management by simultaneously leveraging patient, family, and community strengths are lacking. Methods/design: We report the protocol of the Achieving Blood Pressure Control Together (ACT) study, a randomized controlled trial designed to study the effectiveness of interventions that engage patient, family, and community-level resources to facilitate urban African American hypertensive patients' improved hypertension self-management and subsequent hypertension control. African American patients with uncontrolled hypertension receiving health care in an urban primary care clinic will be randomly assigned to receive 1) an educational intervention led by a community health worker alone, 2) the community health worker intervention plus a patient and family communication activation intervention, or 3) the community health worker intervention plus a problem-solving intervention. All participants enrolled in the study will receive and be trained to use a digital home blood pressure machine. The primary outcome of the randomized controlled trial will be patients' blood pressure control at 12months. Discussion: Results from the ACT study will provide needed evidence on the effectiveness of comprehensive multi-level interventions to improve urban African American patients' hypertension control.
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    • "Even small reductions in high blood pressure have major impacts in clinical outcomes and health care spending: a 2 mm Hg decrease in systolic blood pressure (SBP) or diastolic blood pressure (DBP) significantly reduces risk of stroke, coronary heart disease, and mortality from vascular causes [1]. In the United States, over thirty percent of adults have hypertension, yet of these, only one third achieve normal blood pressure [2,3]. The discrepancy between controlled and uncontrolled hypertensive patients is even wider among ethnic minorities and low-income populations [4]. "
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