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      Adherence treatment factors in hypertensive African American women

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          Abstract

          Background

          Hypertension among African American women is of epidemic proportions. Nonadherence to treatment contributes to uncontrolled blood pressure in this population. Factors associated with adherence to treatment in African American women are unknown. The purpose of this study was to identify factors associated with adherence to hypertension treatment in African American women.

          Methods

          Five audio-taped focus groups were conducted with hypertensive African American women, 35 years and older receiving treatment for hypertension from an inner-city free clinic. All transcripts from the tapes were analyzed for content describing adherence to treatment factors.

          Findings

          Factors associated with adherence to treatment in hypertensive African American women were in three main categories including: beliefs about hypertension, facilitators of adherence to treatment, and barriers to adherence to treatment.

          Implications

          The study supports the need for education on managing hypertension and medication side effects, early screening for depression in hypertensive African Americans, development of culturally sensitive hypertension educational material, and formation of support groups for promoting adherence to treatment among African American women with hypertension.

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          Most cited references51

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          Concurrent and predictive validity of a self-reported measure of medication adherence.

          Adherence to the medical regimen continues to rank as a major clinical problem in the management of patients with essential hypertension, as in other conditions treated with drugs and life-style modification. This article reviews the psychometric properties and tests the concurrent and predictive validity of a structured four-item self-reported adherence measure (alpha reliability = 0.61), which can be easily integrated into the medical visit. Items in the scale address barriers to medication-taking and permit the health care provider to reinforce positive adherence behaviors. Data on patient adherence to the medical regimen were collected at the end of a formalized 18-month educational program. Blood pressure measurements were recorded throughout a 3-year follow-up period. Results showed the scale to demonstrate both concurrent and predictive validity with regard to blood pressure control at 2 years and 5 years, respectively. Seventy-five percent of the patients who scored high on the four-item scale at year 2 had their blood pressure under adequate control at year 5, compared with 47% under control at year 5 for those patients scoring low (P less than 0.01).
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            Adherence to long-term therapies: evidence for action.

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              Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial.

              Weight loss, sodium reduction, increased physical activity, and limited alcohol intake are established recommendations that reduce blood pressure (BP). The Dietary Approaches to Stop Hypertension (DASH) diet also lowers BP. To date, no trial has evaluated the effects of simultaneously implementing these lifestyle recommendations. To determine the effect on BP of 2 multicomponent, behavioral interventions. Randomized trial with enrollment at 4 clinical centers (January 2000-June 2001) among 810 adults (mean [SD] age, 50 [8.9] years; 62% women; 34% African American) with above-optimal BP, including stage 1 hypertension (120-159 mm Hg systolic and 80-95 mm Hg diastolic), and who were not taking antihypertensive medications. Participants were randomized to one of 3 intervention groups: (1) "established," a behavioral intervention that implemented established recommendations (n = 268); (2) "established plus DASH,"which also implemented the DASH diet (n = 269); and (3) an "advice only" comparison group (n = 273). Blood pressure measurement and hypertension status at 6 months. Both behavioral interventions significantly reduced weight, improved fitness, and lowered sodium intake. The established plus DASH intervention also increased fruit, vegetable, and dairy intake. Across the groups, gradients in BP and hypertensive status were evident. After subtracting change in advice only, the mean net reduction in systolic BP was 3.7 mm Hg (P<.001) in the established group and 4.3 mm Hg (P<.001) in the established plus DASH group; the systolic BP difference between the established and established plus DASH groups was 0.6 mm Hg (P =.43). Compared with the baseline hypertension prevalence of 38%, the prevalence at 6 months was 26% in the advice only group, 17% in the established group (P =.01 compared with the advice only group), and 12% in the established plus DASH group (P<.001 compared with the advice only group; P =.12 compared with the established group). The prevalence of optimal BP (<120 mm Hg systolic and <80 mm Hg diastolic) was 19% in the advice only group, 30% in the established group (P =.005 compared with the advice only group), and 35% in the established plus DASH group (P<.001 compared with the advice only group; P =.24 compared with the established group). Individuals with above-optimal BP, including stage 1 hypertension, can make multiple lifestyle changes that lower BP and reduce their cardiovascular disease risk.
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                Author and article information

                Journal
                Vasc Health Risk Manag
                Vascular Health and Risk Management
                Vascular Health and Risk Management
                Dove Medical Press
                1176-6344
                1178-2048
                February 2008
                : 4
                : 1
                : 157-166
                Affiliations
                [1 ]University of California Los Angeles School of Nursing Los Angeles, CA, USA
                [2 ]University of California Los Angeles School of Medicine, Division of General Internal Medicine and Health Services Research Los Angeles, CA, USA
                [3 ]To Help Everyone Clinic Inc. Los Angeles, CA, USA
                [4 ]University of California Los Angeles Public Health Los Angeles, CA, USA
                [5 ]University of California Los Angeles School of Public Health CA, USA
                Author notes
                Correspondence: Marie Fongwa University of California Los Angeles School of Nursing 700 Tiverton Avenue, 3-238 Factor Building Box 956917, Los Angeles, CA 90095-6917, USA Tel +1 310 825 4583 Fax +1 310 267 0413 Email mfongwa@ 123456sonnet.ucla.edu
                Article
                10.2147/vhrm.2008.04.01.157
                2464745
                18629350
                2cd94396-6a09-49e7-ba7b-809b14fa58ea
                © 2008 Fongwa et al, publisher and licensee Dove Medical Press Ltd.
                History
                Categories
                Original Research

                Cardiovascular Medicine
                hypertension treatment factors,adherence,african american
                Cardiovascular Medicine
                hypertension treatment factors, adherence, african american

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