Research has thoroughly identified racial and ethnic disparities in hypertension and cardiovascular health problems in the U.S. among African Americans and Caucasians.1–3
Research has concluded that the prevalence of hypertension among African Americans is among the highest in the United States.4–6
Research has also shown that African Americans experience the onset of hypertension at a younger age and with worse disease severity.4,7
Ferdinand and Armani (2007) conclude that a series of genetic and environmental factors contribute to the high prevalence of hypertension in the African American population.
In addition, Bosworth and colleagues (2006) looked at factors that may explain racial differences in blood pressure control. The authors found that African Americans were more likely to be nonadherent to medication regimens, functionally illiterate, and have a hypertensive family member than their Caucasian counterparts.8
Bosworth and colleagues (2006) concluded that African Americans were more likely to have lower levels of blood pressure control compared to Caucasians, even after controlling for 20 possible explanatory factors. In a more recent study, Bosworth and colleagues (2008) again explored health disparities in blood pressure control. They concluded that age, medication nonadherence, and worrying about blood pressure status contributed to the racial disparity of blood pressure control status.9
Giles and colleagues (2007) similarly found that treated African Americans and Mexican Americans had the lowest rates of treated blood pressure control.10
But, this study, like many others, recommends that interventions for improving medication adherence should take race into account. Though the importance of race to intervention design has been identified across several studies, only a minority of studies have taken the next step to identify specific providers and/or patient characteristics to improve racial awareness in practice.
For example, Kressin and colleagues (2007) looked at race, health beliefs, process of care, and medication adherence in a sample of hypertensive patients. Their research did not find a significant association between race and medication adherence. But, they did find that the providers of African American patients were significantly more active in educating their patients about medication adherence. The authors concluded that racial disparities may be reduced if patients and their providers take hypertension seriously by more actively advising and counseling hypertensive patients about medication use and disease states.11
Rose and colleagues (2000) conducted a qualitative study that explored the contexts of adherence for African American males with high blood pressure. Their qualitative findings suggested that adherence fluctuated depending on social, economic, and personal circumstances, in addition to the empathetic assistance from providers.12
Viswanathan and Lambert (2005) identified several factors that positively affected African-Americans medication adherence as well as factors that negatively impacted consistent use.13
Specifically, reminders of medication effectiveness, lifesaving attributed and a reminder of regimens were found to positively impact medication use. In contrast, factors such as fear of side effects, fear of dependency, and the hassle of taking regularly prescribed medications were among the factors that contributed to African-Americans resistance to consistent medication use.13
Though some research has begun to examine specific factors related to race that should be targeted in the design of interventions to improve medication adherence, there remains an underreporting of factors that contribute to the use of hypertensive medications by race, particularly service level factors. This paper intends to further analyze the association between current medication use and several other covariates, including service level factors, with particular attention to race among the EPESE participants with controlled and uncontrolled hypertension.