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High mortality rates continue among African Americans related to complications of uncontrolled hypertension. The purpose of this study was to determine if a faith-based self-management education program would improve self-care activities related to the management of hypertension among African American adults. Ten African American adults who reported a diagnosis of hypertension for 6 months or longer completed an 8-week education program focused on strategies for hypertension management. The education program was enhanced with the utilization of spiritual components of prayer, Scripture reading, and journaling.

Patient adherence to antihypertensive medication is an important strategy for blood pressure control in hypertensive patients. However, rates of antihypertensive medication adherence among hypertensive African-Americans are unacceptably low. This article examines the current understanding of patient, clinical, provider and healthcare system factors associated with medication adherence in hypertensive African-Americans. Studies demonstrated that patient and clinical factors, such as self-efficacy and depression, are consistently associated with medication adherence in hypertensive African-Americans patients. Provider communication shows promise as a correlate of medication adherence, but more research on provider and healthcare system factors are still needed. The authors recommend that interventions targeted at increasing medication adherence among hypertensive African-Americans focus on self-efficacy. It is also imperative that clinicians screen hypertensive patients for depression and treat, if necessary.

Background: Rates of medication adherence are low among hypertensive blacks despite numerous interventions to increase their adherence., Purpose: The aim of the study was to conduct a systematic review of the literature to understand the factors associated with medication adherence in hypertensive blacks., Methods: A systematic computer search of qualitative and quantitative studies that examined factors associated with medication adherence in hypertensive blacks from 1966 to 2010 was performed. Studies were excluded if medication adherence was not either the primary or secondary outcome variable., Results: Studies (n = 18) were cross-sectional or qualitative, measured adherence via self-report, and conducted in low-income blacks. Factors that were associated with medication adherence were self-efficacy, depression, patient-provider communication, and healthcare system related., Conclusions: Findings from existing studies should be interpreted with caution because of their methodological limitations. Longitudinal studies with heterogeneous samples of hypertensive blacks are imperative so that targeted interventions can be developed for this vulnerable population., Clinical Implications: Even though there are methodological limitations associated with existing studies, clinicians may want to consider some of the factors that were associated with medication adherence in this systematic review as they provide care for hypertensive blacks. Given that self-efficacy and patient-provider communication are modifiable factors, they can be the focus of interventions to increase medication adherence. Finally, clinicians may want to screen their hypertensive patients for depression and treat, if necessary.

The problem of medication adherence is pronounced in hypertensive black men. However, factors influencing their adherence are not well understood. This secondary analysis of the ongoing Counseling African Americans to Control Hypertension (CAATCH) randomized clinical trial investigated the patient, provider, and health care system factors associated with medication adherence among hypertensive black men. Participants (N=253) were aged 56.6±11.6 years, earned <$20,000 yearly (72.7%), and almost one half were on Medicaid (44%). Mean systolic blood pressure was 148.7±15.8 mm Hg and mean diastolic blood pressure was 92.7±9.8 mm Hg. Over one half of participants (54.9%) were nonadherent. In a hierarchical regression analysis, the patient factors that predicted medication adherence were age, self-efficacy, and depression. The final model accounted for 32.1% of the variance (F=7.80, df 10, 165, P<.001). In conclusion, age, self-efficacy, and depression were associated with antihypertensive medication adherence in black men followed in Community/Migrant Health Centers. Age is a characteristic that may allow clinicians to predict who may be at risk for poor medication adherence. Depression can be screened for and treated. Self-efficacy is modifiable and its implications for practice would be the development of interventions to increase self-efficacy in black men with hypertension., (© 2012 Wiley Periodicals, Inc.)

The purpose of this qualitative study was to explore how African American older adults use spirituality to adhere to their antihypertensive medications. Data collection included in-depth individual interviews with 21 older African American women. Content analysis revealed five themes: The Lord Helps Those Who Help Themselves; Staying in the Lord for Guidance; God Is My Rock; Guardian Angels and Saints; and Brings Me Peace, Ease of Burdens, and Ability to Cope. Findings of this study suggest that spirituality is perceived as a positive resource that helps study participants adhere to their antihypertensive medication regimen. Possible faith-based interventions for nurses and other health care professionals to use with their patients are discussed.

Background and Objective: Medication adherence is low among hypertensive patients regardless of ethnic background. However, the prevalence of nonadherence is higher among African Americans when compared with their white American counterparts. Recognizing African American perspectives about their adherence to antihypertensive medications is necessary for the development of successful interventions aimed at improving adherence to prescribed regimens. The purpose of this qualitative study was to explore community-dwelling hypertensive African American behavioral, normative, and control beliefs regarding their adherence to antihypertensive medications., Subjects and Methods: A community and academic partnership was formed to conduct 3 audio-taped focus groups with 40 hypertensive and low-income African American adults aged 18 years and older. Interview questions were based on the theory of planned behavior. All transcripts from the tapes were analyzed using thematic analysis., Results and Conclusions: Behavioral beliefs associated with medication adherence identified both positive and negative outcomes. Family, friends, neighbors, and God were associated with normative beliefs. Limited financial resources, neighborhood violence, and distrust of healthcare professionals were key control beliefs. Although these results cannot be generalized, they do provide significant insight into the contextual factors associated with the lives of community-dwelling hypertensive African Americans who fit a similar demographic profile. These findings are important because they can be used to tailor interventions to increase their medication adherence.

Objective: To describe perceived health and assess the factors that contribute to perceived health in community-dwelling older adults diagnosed with hypertension., Methods: The study was a secondary analysis of data from a cross-sectional study that examined community-dwelling adults' health status, use of health services, and access to care. Hierarchical regression identified factors that contributed to perceived health in 1485 adults aged 60 years and older who were diagnosed with hypertension., Results: A model of nonmodifiable factors, support resources, and lifestyle factors explained a significant proportion of the variance in perceived health, most of which was captured by nonmodifiable factors., Conclusion: Attention to nonmodifiable factors is needed in both clinical practice and research to identify a subset of older adults diagnosed with hypertension who are at risk for poor perceived health., (2010 Elsevier Inc. All rights reserved.)

Racial disparities in hypertension prevalence and its attendant complications are well documented. Spirituality is an important component of African American beliefs and a small body of literature suggests that spirituality influences hypertension management in African Americans. This article describes a conceptual model of spirituality that may be useful for developing interventions for increasing medication adherence and decreasing blood pressure in African Americans diagnosed with hypertension.