title: Association of race consciousness with the patient-physician relationship, medication adherence, and blood pressure in urban primary care patients.
abstract: BACKGROUND
  Race consciousness (the frequency with which one thinks about his or her own race) is a measure that may be useful in assessing whether racial discrimination negatively impacts blood pressure (BP). However, the relation between race consciousness and BP has yet to be empirically tested, especially within the context of the patient-physician relationship and medication adherence.
  
  
  METHODS
  Race-stratified generalized estimating equations were used to assess the relationship of race consciousness on BP, measures of the patient-physician relationship, and self-reported medication adherence, controlling for patients being nested within physicians and for patient age and sex.
  
  
  RESULTS
  The mean age of the patients was 61.3 years, 62% were black, and 65% were women. Black patients were more likely to ever think about race than were white patients (49% vs. 21%; P < 0.001). Race-conscious blacks had significantly higher diastolic BP (79.4 vs. 74.5 mm Hg; P = 0.004) and somewhat higher systolic BP (138.8 vs. 134.7 mm Hg; P = 0.13) than blacks who were not race conscious. Race-conscious whites were more likely to perceive respect from their physician (57.1% vs. 25.8%; P = 0.01) but had lower medication adherence (62.4% vs. 82.9%; P = 0.05) than whites who were not race-conscious.
  
  
  CONCLUSIONS
  Among blacks, race consciousness was associated with higher diastolic BP. In contrast, among whites, there was no association between race consciousness and BP, but race consciousness was associated with poor ratings of adherence, despite more favorable ratings of the patient-physician relationship. Future work should explore disparities in race consciousness and its impact on health and health-care disparities.
authors.affiliation: Department of Medicine, Mayo Clinic, Rochester, Minnesota; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota;
authors.forename: LaPrincess C
authors.initials: LC
authors.lastname: Brewer
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland;
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Carson
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts;
authors.forename: David R
authors.initials: DR
authors.lastname: Williams
authors.affiliation: Department of Community & Applied Social Psychology, University of Maryland, Baltimore County, Baltimore, Maryland;
authors.forename: Allyssa
authors.initials: A
authors.lastname: Allen
authors.affiliation: Morehouse School of Medicine, Atlanta, Georgia; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Camara P
authors.initials: CP
authors.lastname: Jones
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; lisa.cooper@jhmi.edu.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Cooper
mesh_terms: D000368:Aged; D015142:Baltimore; D001794:Blood Pressure; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000706:statistics & numerical data*; D044469:Racial Groups / Q000523:psychology*; D013315:Stress, Psychological; D014505:Urban Population / Q000706:statistics & numerical data; D016903:Drug Monitoring
keywords: adherence; blood pressure; blood pressure discrimination; disparities; hypertension; perceived quality of care; race; racism.