This prospective study, Shaping Cognitive Representations for Hypertensive Women, evaluates a treatment protocol for enhancing compliance with BP medication as a means of lowering blood pressure (BP) in women with hypertension (HTN). Currently, compliance with daily antihypertensive medication regimens is recommended for treating essential HTN. For some people, compliance is extremely difficult due to knowledge deficits, denial of need for treatment, inadequate access to health care, and problems with interacting with health care providers. The high incidence of uncontrolled BP in middle-aged African American women (AAW) who are being treated for HTN suggests chronic noncompliance with medical regimens. Cognitive Representations (CRs) are enduring memories of beliefs, attitudes and intentions for behavior that organize knowledge for decisions to guide behavior. Since CRs involve integration of perceptual stimuli for the purpose of appraising, coping, adapting, and learning they may be linked to noncompliance with HTN treatment. Preliminary data examining CRs of Medication Behaviors (CRMBs) demonstrated that AAW manifested higher BP and more maladaptive CRMB than White American women. Thus, a theoretically derived Cognitive-Behavioral Intervention (CBI) may be effective in decreasing noncompliance and uncontrolled BP. This 4-year, longitudinal study will test the effectiveness of a CBI in improving medication compliance and managing HTN in White and African American women (N=160). Women will be recruited into the study if they: (1) have Stage I or II HTN (systolic blood pressure 140 mmHg or diastolic 90 mmHg), (2) are 34-65 years old. They will be randomly assigned to either the CBI or a standard medical therapy group and stratified by racial identity and complexity of treatment regimen. The CBI will require participants to perform a 20-minute daily self-monitored learning program using specially designed tailored message wheels about medication behavior for 30 days. All study participants will receive 24-hour ambulatory BP monitoring and be asked to take their medication from a special container with an electronic monitoring (MEMS) cap. Over the 6-month study period (baseline, 90 days, 180 days), they also will complete questionnaires related to: (a) Knowledge of HTN, (b) general sense of well-being; and (c) CRMBs. Descriptive, parametric and nonparametric statistical procedures will be used to analyze the research hypotheses and report results.
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