title: Antihypertensive medication nonadherence in black men: direct and mediating effects of depressive symptoms, psychosocial stressors, and substance use.
abstract: Black men suffer disproportionately from hypertension. Antihypertensive medication nonadherence is a major contributor to poor blood pressure control, yet few studies consider how psychosocial functioning may impact black men's medication adherence. The authors examined the direct and mediating pathways between depressive symptoms, psychosocial stressors, and substance use on antihypertensive medication nonadherence in 196 black men enrolled in a clinical trial to improve hypertension care and control. The authors found that greater depressive symptoms were associated with more medication nonadherence (β=0.05; standard error [SE], 0.01; P<.001). None of the psychosocial stressor variables were associated with antihypertensive medication nonadherence. Alcohol misuse was associated with increased medication nonadherence (β=0.81; SE, 0.26; P<.01), but it did not mediate the association between depressive symptoms and medication nonadherence. Clinicians should consider screening for depressive symptoms and alcohol misuse if patients are found to be nonadherent and should treat or refer patients to appropriate resources to address those issues.
authors: Division of General Internal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7110, USA. ccene@med.unc.edu
authors: Crystal W
authors: CW
authors: Cené
authors: Cheryl R
authors: CR
authors: Dennison
authors: Wizdom
authors: W
authors: Powell Hammond
authors: David
authors: D
authors: Levine
authors: Lee R
authors: LR
authors: Bone
authors: Martha N
authors: MN
authors: Hill
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D003863:Depression / Q000523:psychology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000523:psychology; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data; D012307:Risk Factors; D013315:Stress, Psychological / Q000523:psychology*; D019966:Substance-Related Disorders / Q000188:drug therapy / Q000523:psychology*; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D000959:Antihypertensive Agents