Division of General Internal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7110, USA.
J Clin Hypertens (Greenwich). 2013 Mar;15(3):201-9. doi: 10.1111/jch.12056. Epub 2012 Dec 26.
Black men suffer disproportionately from hypertension. Antihypertensive medication nonadherence is a major contributor to poor blood pressure control, yet few studies consider how psychosocial functioning may impact black men's medication adherence. The authors examined the direct and mediating pathways between depressive symptoms, psychosocial stressors, and substance use on antihypertensive medication nonadherence in 196 black men enrolled in a clinical trial to improve hypertension care and control. The authors found that greater depressive symptoms were associated with more medication nonadherence (β=0.05; standard error [SE], 0.01; P<.001). None of the psychosocial stressor variables were associated with antihypertensive medication nonadherence. Alcohol misuse was associated with increased medication nonadherence (β=0.81; SE, 0.26; P<.01), but it did not mediate the association between depressive symptoms and medication nonadherence. Clinicians should consider screening for depressive symptoms and alcohol misuse if patients are found to be nonadherent and should treat or refer patients to appropriate resources to address those issues.
黑人男性患高血压的比例不成比例。抗高血压药物不依从是导致血压控制不佳的主要原因，但很少有研究考虑心理社会功能如何影响黑人男性的药物依从性。作者在一项旨在改善高血压治疗和控制的临床试验中，检查了 196 名黑人男性的抑郁症状、心理社会压力源和物质使用与抗高血压药物不依从之间的直接和中介途径。作者发现，更多的抑郁症状与更多的药物不依从（β=0.05；标准误差 [SE]，0.01；P<.001）相关。心理社会压力源变量均与抗高血压药物不依从无关。酒精滥用与药物不依从增加有关（β=0.81；SE，0.26；P<.01），但它并没有介导抑郁症状与药物不依从之间的关系。如果发现患者不依从，临床医生应考虑筛查抑郁症状和酒精滥用，并应治疗或转介患者到适当的资源来解决这些问题。
