In the United States, prevalence of high blood pressure in African-Americans is among the highest in the world. Prevalence of hypertension for non-Hispanic blacks age 20 and older is 50 percent higher than among non-Hispanic whites. African-Americans develop high blood pressure at an earlier age and are more likely to have poorly controlled blood pressure. Blacks have a 1.8 times greater rate of fatal stroke, a 1.5 times greater rate of heart disease death and a 4.2 times greater rate of end-stage hypertension-related kidney disease than whites. Adherence with anti-hypertensive medications can help reduce risk of negative outcomes. Motivational interviewing is a promising patient-centered approach for improving treatment compliance. This technique consists of brief, patient-driven counseling sessions to facilitate initiation and maintenance of behavior change. This study will assess whether adherence can be enhanced through motivational interviewing, an integrated, multiple-component, and culturally-sensitive intervention. The proposed study is a longitudinal, randomized controlled trial of 190 poorly controlled hypertensive patients. Subjects will be recruited from a community-based primary care practice and randomly assigned to one of two conditions: non-supportive counseling or motivational interviewing. Patients in both arms will have 4 sessions of either non-supportive counseling or motivational interviewing at 3-month intervals after randomization. The primary outcome is medication adherence and the secondary outcomes are changes in systolic and diastolic blood pressure between baseline and one-year follow-up assessment. Changes in medication-adherence self-efficacy will also be measured. The long-term objective is to determine whether better adherence to prescribed medications can be achieved through motivational interviewing, leading to reduction in hypertension-related outcomes like end-stage renal disease, cardiovascular mortality and stroke among African-American patients with poorly controlled hypertension.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
3R01HL069408-02S1
Application #
6767203
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Czajkowski, Susan
Project Start
2001-09-26
Project End
2005-08-31
Budget Start
2002-09-01
Budget End
2003-08-31
Support Year
2
Fiscal Year
2003
Total Cost
$7,850
Indirect Cost
Name
Weill Medical College of Cornell University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
060217502
City
New York
State
NY
Country
United States
Zip Code
10065
Solomon, Abida; Schoenthaler, Antoinette; Seixas, Azizi et al. (2015) Medication Routines and Adherence Among Hypertensive African Americans. J Clin Hypertens (Greenwich) 17:668-72
Knafl, George J; Schoenthaler, Antoinette; Ogedegbe, Gbenga (2012) Secondary analysis of electronically monitored medication adherence data for a cohort of hypertensive African-Americans. Patient Prefer Adherence 6:207-19
Schoenthaler, Antoinette; Ogedegbe, Gbenga; Allegrante, John P (2009) Self-efficacy mediates the relationship between depressive symptoms and medication adherence among hypertensive African Americans. Health Educ Behav 36:127-37
Ogedegbe, Gbenga; Chaplin, William; Schoenthaler, Antoinette et al. (2008) A practice-based trial of motivational interviewing and adherence in hypertensive African Americans. Am J Hypertens 21:1137-43
Fernandez, Senaida; Scales, Kasandra L; Pineiro, Johanna M et al. (2008) A senior center-based pilot trial of the effect of lifestyle intervention on blood pressure in minority elderly people with hypertension. J Am Geriatr Soc 56:1860-6
Fernandez, Senaida; Chaplin, William; Schoenthaler, Antoinette M et al. (2008) Revision and validation of the medication adherence self-efficacy scale (MASES) in hypertensive African Americans. J Behav Med 31:453-62
Ogedegbe, Gbenga; Schoenthaler, Antoinette; Fernandez, Senaida (2007) Appointment-keeping behavior is not related to medication adherence in hypertensive African Americans. J Gen Intern Med 22:1176-9
Ogedegbe, Gbenga; Schoenthaler, Antoinette; Richardson, Tabia et al. (2007) An RCT of the effect of motivational interviewing on medication adherence in hypertensive African Americans: rationale and design. Contemp Clin Trials 28:169-81
Ogedegbe, Gbenga (2006) Role of home blood pressure and ambulatory blood pressure monitoring in decisions of when and whom to treat: recommendations for practicing clinicians. J Cardiometab Syndr 1:222-4
Ogedegbe, Gbenga; Schoenthaler, Antoinette (2006) A systematic review of the effects of home blood pressure monitoring on medication adherence. J Clin Hypertens (Greenwich) 8:174-80

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