1052. Hypertension Medication Adherence: Racial, Clinical, Psychosocial Factors
Hayden B Bosworth, PhD, Center for Health Services Research in Primary Care, Durham VAMC, MK Olsen, Center for Health Services Research in Primary Care, Durham VAMC, R Dudley,
Center for Health Services Research in Primary Care, Durham VAMC, MK Goldstein,
Geriatrics Research Education & Clinical Center, VA Palo Alto Healthcare System and Center for Health Services Research in Primary Care, Durham VAMC, EZ Oddone,
Center for Health Services Research in Primary Care, Durham VAMC
Objectives: Antihypertensive medication nonadherence is a common problem that contributes to poor blood pressure (BP) control. We explored differences by race in self-reported antihypertensive medication adherence and factors mediating nonadherence.
Methods: Baseline data were obtained from the Veteranís-Study to Improve The Control of Hypertension (V-STITCH); a randomized controlled primary care based intervention trial to improve BP control. Clinical, demographic, and psychosocial factors related to medication adherence were examined. The outcome was whether patients reported that they sometimes forgot to take their antihypertensive medication.
Results: 569 patients who were either African-American (41%) or white (59%) were enrolled in the trial. Twenty-four percent of the white and 37% of the African-Americans reported they sometimes forgot to take their antihypertensive medication (OR= 1.92; 95% CI 1.33-2.76). None of the clinical, psychosocial or demographic variables were associated with non-adherence. Variables tested in the analysis after considering collinearity included: education, income, antihypertensive side effects, diabetes, social support, participatory decision making, length of hypertension diagnosis, family history of hypertension, literacy (REALM), perceived risk of hypertension, knowledge, exercise and smoking behavior, use of home BP monitor, and locus of control.
Conclusions: In this sample of hypertensive patients recruited from a VA hospital primary care setting, African-Americans reported forgetting to take their antihypertensive medication more frequently than whites, controlling for multiple possible mediating factors.
Impact: Interventions designed to improve adherence need to take race into account. Patientís self-report of failure to take medications provides an opportunity for clinicians to explore reasons for medication non-adherence and thereby improve adherence.