Confidence, positive feelings support better medication adherence in hypertensive African-Americans

When it comes to taking prescribed medications for hypertension, a patient's self confidence could be as important as doctor's orders. A new study by researchers at NYU School of Medicine reveals that positive affirmation, when coupled with patient education, seems to help patients more effectively follow their prescribed medication regimen.

The study, funded by the National Heart, Lung, and Blood Institute, appears online ahead of print today in the Archives of Internal Medicine.

"As doctors, we're always trying to do the right thing for our patients and get them to do the right thing for themselves – change their habits, adopt healthier lifestyles," said lead author Gbenga O. Ogedegbe, MD, of the Center for Healthful Behavior Change (CHBC) at NYU School of Medicine. "Patients know what the doctors tell them they should do. Often however, knowledge of what to do and the consequences of not doing so are not sufficient. With this study, we were looking for a way to effectively increase motivation and improve patients' medication taking behavior, as hypertension is a serious problem in this country."

For the study, Ogedegbe and colleagues enrolled 256 hypertensive African-Americans and randomized them into two study groups. Patients in both groups received a hypertension self-management workbook, a behavioral contract that asked participants to make a commitment to taking their medications as prescribed, and bimonthly telephone calls to help the participants overcome barriers to medication compliance. Additionally, patients in the intervention group were given an extra chapter in their workbook that addressed the benefits of positive moments in overcoming obstacles to taking their blood pressure medications. They were also encouraged during their bimonthly calls to identify small things in their lives that invoke positive feelings and to incorporate those positive thoughts into their daily routines. As part of the intervention, these participants received unexpected small gifts mailed to them before each telephone call and were asked to remember their core values and proud moments in their lives whenever they encounter situations that make it difficult for them to take their medications.

Researchers followed the participants for one year and then compared medication adherence between the two groups for the study period.

They found that participants in the intervention group had 22 percent higher adherence rates than those in the control group, indicating that enhancing simple patient education with positive psychology can have a significant impact on adherence rates, particularly in hypertensive African-Americans.

"Other studies have shown that positive feelings can affect health behavior, but to our knowledge, no previous studies have looked at the effect of positive feelings on medication adherence," said co-investigator Joseph E. Ravenell, MD, also of the CHBC. "This is a relatively simple target that may have a huge impact and certainly a path we should pursue to combat cardiovascular disease. It's possible that, with future research, the findings could extend to a broader range of medical conditions, as well."

The study was conducted in African-Americans, who are disproportionately affected by hypertension compared to whites and suffer worse hypertension-related outcomes. Poor medication adherence may explain, to some extent, poor blood pressure control in hypertensive patients – especially African-Americans – which can lead to serious cardiovascular problems and death.

Hypertension – or high blood pressure – is one of the most serious known contributors of heart disease, the leading cause of death in the United States. One in three adults in the country has hypertension, according to the National Institutes of Health, which estimated that number to be more than 76 million people in 2008.

Dr. Ogedegbe is a clinical epidemiologist, hypertension specialist, and behavioral scientist with expertise in development, implementation and translation of evidence-based behavioral interventions targeted at cardiovascular risk reduction in minority populations into primary care practices and community-based settings. He and other researchers involved with the CHBC at the School of Medicine, are dedicated to translating research into clinical improvements in medicine by finding simple strategies that physicians and other individuals in healthcare can use in real world settings to improve patient health.