Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.
Rollins School of Public Health, Emory University, Atlanta, Georgia.
J Clin Hypertens (Greenwich). 2019 Nov;21(11):1695-1704. doi: 10.1111/jch.13712. Epub 2019 Sep 26.
Hypertension, a modifiable risk factor of cardiovascular disease, is largely responsible for the disproportionate morbidity and mortality in black women. Black women 20 years of age and older have a higher prevalence of HTN compared to white women (44% vs 28%). Poor adherence and non-adherence to hypertensive medications have been strongly indicated as a primary contributor to the early onset of disparity in cardiovascular disease morbidity and mortality experienced by black people. The purpose of this study was to examine medication adherence in black women relative to sociodemographic, clinical, cultural context, psychosocial, cognitive, and behavioral factors. This was a prospective, descriptive cross-sectional study of N = 85, hypertensive black women, with mean age of 39 ± 5.4 years, 18-45 years of age. Variables and measures included: sociodemographic characteristics, clinical, adverse social stressors, psychosocial, cognitive-behavioral factors, and medication adherence. Descriptive statistics, correlations, multivariate logistic regressions, and moderation analysis were tested. 81.2% (n = 69) of the sample was categorized as non-adherent. SBP was the only clinical covariate associated with HTN medication adherence. HTN illness perceptions, composite score, resilient coping, depressive symptoms, exposure to lifetime gender, and racial stressors, were not associated with HTN medication adherence. Using multivariate logistic regression, decreased SBP and lower scores on the "Consequence" dimension of the HTN illness perception scale were associated with medication adherence (χ = 10.53, P = .001). Adherence was associated with both the "Consequence" and "Identity" dimensions of the HTN illness perception scale indicating the need and importance for clinicians to have open and honest communication regarding HTN and its treatment in facilitating adherence.
高血压是心血管疾病的一个可改变的风险因素，在很大程度上导致了黑人女性不成比例的发病率和死亡率。年龄在 20 岁及以上的黑人女性患高血压的比例高于白人女性（44%比 28%）。高血压药物治疗的依从性差或不依从性被强烈认为是导致黑人患心血管疾病发病率和死亡率早期出现差异的一个主要原因。本研究的目的是检查与社会人口统计学、临床、文化背景、心理社会、认知和行为因素相关的黑人女性的药物依从性。这是一项前瞻性、描述性的横断面研究，共纳入 85 名高血压黑人女性，平均年龄 39±5.4 岁，年龄在 18-45 岁之间。变量和测量包括：社会人口统计学特征、临床、不良社会压力源、心理社会、认知行为因素和药物依从性。采用描述性统计、相关性、多元逻辑回归和调节分析进行检验。样本中 81.2%（n=69）的人被归类为不依从者。SBP 是唯一与高血压药物依从性相关的临床协变量。高血压疾病感知、综合得分、弹性应对、抑郁症状、一生中经历的性别和种族压力与高血压药物依从性无关。使用多元逻辑回归分析，SBP 降低和高血压疾病感知量表“后果”维度得分较低与药物依从性相关（χ 2=10.53，P=0.001）。依从性与高血压疾病感知量表的“后果”和“身份”维度相关，这表明临床医生需要就高血压及其治疗进行开诚布公的沟通，以促进依从性。
