Kressin Nancy R, Wang Fei, Long Judith, Bokhour Barbara G, Orner Michelle B, Rothendler James, Clark Christine, Reddy Surekha, Kozak Waldemar, Kroupa Laura P, Berlowitz Dan R
Center for Health Quality, Outcomes and Economic Research, Bedford VA Medical Center, Bedford, MA, USA.
J Gen Intern Med. 2007 Jun;22(6):768-74. doi: 10.1007/s11606-007-0165-9. Epub 2007 Mar 16.
African Americans have higher rates of hypertension and worse blood pressure (BP) control than Whites, and poorer medication adherence may contribute to this phenomenon. We explored associations among patients' race, self-reported experiences with clinicians, attitudes and beliefs about hypertension, and ultimately, medication adherence, among a sample with no racial disparities in BP control, to determine what lessons we could learn from patients and providers in this setting.
We recruited 793 White and African-American (58%) patients previously diagnosed with hypertension from 3 VA medical centers to participate in survey assessments of each of the above dimensions, subsequent to a primary care clinic visit.
African-American patients' providers were significantly more active in advising and counseling about hypertension care and medication adherence. African-American patients indicated greater knowledge or heightened awareness of the importance of controlling their BP, but there were no race differences on a summary adherence measure. In multivariate models modeling medication adherence, race was not significant, but having been told to split one's pills, believing one's BP continues to be high, and having one's provider discuss things to do to make it easier to take BP medications were each significantly associated with worse adherence, whereas having more confidence in one's ability to take BP medications as prescribed was associated with better adherence (all p's < or = .02).
When both physicians and patients take BP management seriously, disparities in BP adherence and control may be reduced.
非裔美国人高血压发病率高于白人，血压控制情况也更差，而较差的药物依从性可能是导致这一现象的原因。我们在血压控制方面不存在种族差异的样本中，探讨了患者的种族、与临床医生的自我报告经历、对高血压的态度和信念，以及最终的药物依从性之间的关联，以确定在此背景下我们能从患者和医疗服务提供者身上学到什么。
我们从3家退伍军人事务部医疗中心招募了793名先前被诊断为高血压的白人和非裔美国人（58%）患者，在他们进行初级保健门诊就诊后，对上述每个维度进行调查评估。
非裔美国患者的医疗服务提供者在高血压护理和药物依从性的建议及咨询方面明显更积极。非裔美国患者表示对控制血压的重要性有更多了解或更高认识，但在综合依从性指标上没有种族差异。在对药物依从性进行建模的多变量模型中，种族并不显著，但被告知分药、认为自己血压仍然很高，以及医疗服务提供者讨论使服用降压药更容易的方法，这些都与较差的依从性显著相关，而对按规定服用降压药的能力更有信心则与更好的依从性相关（所有p值≤0.02）。
当医生和患者都认真对待血压管理时，血压依从性和控制方面的差异可能会减少。
