title: A randomized controlled trial of positive-affect intervention and medication adherence in hypertensive African Americans.
abstract: BACKGROUND
  Poor adherence explains poor blood pressure (BP) control; however African Americans suffer worse hypertension-related outcomes.
  
  
  METHODS
  This randomized controlled trial evaluated whether a patient education intervention enhanced with positive-affect induction and self-affirmation (PA) was more effective than patient education (PE) alone in improving medication adherence and BP reduction among 256 hypertensive African Americans followed up in 2 primary care practices. Patients in both groups received a culturally tailored hypertension self-management workbook, a behavioral contract, and bimonthly telephone calls designed to help them overcome barriers to medication adherence. Also, patients in the PA group received small gifts and bimonthly telephone calls to help them incorporate positive thoughts into their daily routine and foster self-affirmation. The main outcome measures were medication adherence (assessed with electronic pill monitors) and within-patient change in BP from baseline to 12 months.
  
  
  RESULTS
  The baseline characteristics were similar in both groups: the mean BP was 137/82 mm Hg; 36% of the patients had diabetes; 11% had stroke; and 3% had chronic kidney disease. Based on the intention-to-treat principle, medication adherence at 12 months was higher in the PA group than in the PE group (42% vs 36%, respectively; P =.049). The within-group reduction in systolic BP (2.14 mm Hg vs 2.18 mm Hg; P = .98) and diastolic BP (-1.59 mm Hg vs -0.78 mm Hg; P = .45) for the PA group and PE group, respectively, was not significant.
  
  
  CONCLUSIONS
  A PE intervention enhanced with PA led to significantly higher medication adherence compared with PE alone in hypertensive African Americans. Future studies should assess the cost-effectiveness of integrating such interventions into primary care. Trial Registration clinicaltrials.gov Identifier: NCT00227175.
authors.affiliation: New York Univeristy School of Medicine, New York, NY 10010, USA. Olugbenga.Ogedegbe@nyumc.org
authors.forename: Gbenga O
authors.initials: GO
authors.lastname: Ogedegbe
authors.forename: Carla
authors.initials: C
authors.lastname: Boutin-Foster
authors.forename: Martin T
authors.initials: MT
authors.lastname: Wells
authors.forename: John P
authors.initials: JP
authors.lastname: Allegrante
authors.forename: Alice M
authors.initials: AM
authors.lastname: Isen
authors.forename: Jared B
authors.initials: JB
authors.lastname: Jobe
authors.forename: Mary E
authors.initials: ME
authors.lastname: Charlson
mesh_terms: D001741:Black or African American / Q000193:education / Q000523:psychology; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D019468:Disease Management; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000208:ethnology / Q000523:psychology; D008297:Male; D055118:Medication Adherence / Q000208:ethnology / Q000523:psychology; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010353:Patient Education as Topic / Q000379:methods*; D011320:Primary Health Care / Q000379:methods; D012646:Self Administration / Q000523:psychology; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents