title: Hypertensive patients' race, health beliefs, process of care, and medication adherence.
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 < or = .02).
  
  
  CONCLUSIONS
  When both physicians and patients take BP management seriously, disparities in BP adherence and control may be reduced.
authors.affiliation: Center for Health Quality, Outcomes and Economic Research, Bedford VA Medical Center, Bedford, MA, USA. nkressin@bu.edu
authors.forename: Nancy R
authors.initials: NR
authors.lastname: Kressin
authors.forename: Fei
authors.initials: F
authors.lastname: Wang
authors.forename: Judith
authors.initials: J
authors.lastname: Long
authors.forename: Barbara G
authors.initials: BG
authors.lastname: Bokhour
authors.forename: Michelle B
authors.initials: MB
authors.lastname: Orner
authors.forename: James
authors.initials: J
authors.lastname: Rothendler
authors.forename: Christine
authors.initials: C
authors.lastname: Clark
authors.forename: Surekha
authors.initials: S
authors.lastname: Reddy
authors.forename: Waldemar
authors.initials: W
authors.lastname: Kozak
authors.forename: Laura P
authors.initials: LP
authors.lastname: Kroupa
authors.forename: Dan R
authors.initials: DR
authors.lastname: Berlowitz
mesh_terms: D001741:Black or African American; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001294:Attitude to Health; D003142:Communication; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000208:ethnology*; D008875:Middle Aged; D010349:Patient Compliance; D010817:Physician-Patient Relations; D011320:Primary Health Care; D044465:White People
chemical_list: D000959:Antihypertensive Agents