Abstract 11070: Antihypertensive Medication Challenges, Adherence, and Blood Pressure in African Americans with a History of Uncontrolled Hypertension

Abstract

Introduction: African American adults with uncontrolled hypertension may have structural inequities in access to, intensity of, as well as greater challenges using antihypertensive medications, all of which may contribute to inadequate blood pressure (BP) control. Traditional self-reported measures of adherence suffer from social desirability bias and are not consistently correlated with BP control. Hypothesis: African Americans with higher systolic BP (SBP) experience more medication challenges (access, med taking) that are correlated with BP. Methods: Data at baseline are from a cluster randomized trial of patient-level coaching vs. practice level facilitation and the combination of the two interventions in 1596 adult African American patients (39% male; mean age 57 ± 12 yrs.) seen in rural primary care practices with a history of uncontrolled hypertension (average over the last year ≥ 140/90 mmHg). In bivariate and correlation analyses, we examined the cross-sectional association of self-reported medication adherence vs. self-reported medication challenges with SBP level at baseline. These relationships were further examined in a linear regression model with SBP as the outcome while controlling for age, gender, and annual income. Results: Patients were taking a mean of 2.4 antihypertensive medications. SBP level was significantly correlated with the number of antihypertensive medication challenges reported (p < 0.01). While those reporting lower medication adherence also reported significantly more medication challenges, mean SBP was not significantly different by self-reported medication adherence level. However, mean SBP was significantly higher in patients reporting 4 or more medication challenges (158 vs. 155mmHg, p=0.004). In linear regression analysis, age, income, and self-reported medication challenges (β = 0.3; .95% CI: 0.03 - 0.6; p = 0.028) were independently associated with SBP level while gender and self-reported medication adherence were not. Conclusion: African Americans with uncontrolled BP often require more intensive antihypertensive regimens. However, such regimens may be associated with more medication challenges that may adversely impact adherence and BP control.