Among black patients with hypertension, patient
education with positive-affect induction and self-affirmation led to higher
medication adherence compared with patient education alone, according to
results from a recent study.
Poor medication adherence among blacks with hypertension
could explain poor BP control, Gbenga O. Ogedegbe, MD, of the Center for
Healthful Behavior Change at New York University School of Medicine, and
colleagues wrote. To reduce the racial gap in hypertension-related outcomes,
interventions that improve medication adherence are needed.
Gbenga O. Ogedegbe
Evidence suggests that successful interventions
designed to improve medication adherence in patients with chronic diseases use
a combined strategy, with the behavioral education combination being the one
most frequently used, the researchers wrote.
Researchers randomly assigned 256 black patients (mean
age, 58 years) who were using at least one antihypertensive medication to
receive patient education only or an intervention designed to educate and
enhance positive feelings. Both groups received culturally tailored
hypertension self-management workbooks, a behavioral contract and bimonthly
telephone calls to help patients overcome barriers to medication adherences.
However, to foster self-affirmation, the intervention group also received small
gifts and bimonthly telephone calls to incorporate positive thoughts into their
Among both groups, mean baseline BP was 137 mm Hg/82 mm
Hg. Additionally, 36% of patients had diabetes, 11% had stroke and 3% had
chronic kidney disease. Two-thirds of patients had uncontrolled hypertension.
At 12 months, study results showed that medication
adherence was higher in the intervention group (42%) vs. the control group
(35%; P=.049). The intention-to-treat analysis also revealed that
approximately one in 16 patients would benefit from the intervention. Changes
in BP were not statistically significant, with the intervention group
experiencing a 2.14-mm Hg within-group reduction in systolic BP and the control
group experiencing a 2.18-mm Hg within-group reduction (P=.98),
according to study results. Similarly, decreases in diastolic BP were 1.59 mm
Hg in the intervention group and 0.78 mm Hg in the control group
In an accompanying editorial, Geoffrey C. Williams,
MD, PhD, and Christopher P. Niemiec, PhD, both of the department of
clinical and social sciences in psychology at the University of Rochester, said
maintenance of health-change behavior occurs through autonomous self-regulation
and perceived competence.
We recommend that future research target positive
affect and self-affirmation in a context of support for satisfaction of the
basic psychological needs for autonomy, competence and relatedness,
Williams and Niemiec concluded.
For more information:
Disclosure: Drs. Ogedegbe, Niemiec and Williams
report no relevant financial disclosures.