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.
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