TY  - JOUR
T1  - A randomized controlled trial of positive-affect intervention and medication adherence in hypertensive african americans
AU  - Ogedegbe GO, Boutin-Foster C, Wells MT, et al
Y1  - 2012/02/27
N1  - 10.1001/archinternmed.2011.1307
JO  - Archives of Internal Medicine
SP  - 322
EP  - 326
VL  - 172
IS  - 4
N2  - Background 
                  Poor adherence explains poor blood pressure (BP) control; however African Americans suffer worse hypertension-related outcomes.Methods 
                  This randomized controlled trial evaluated whether a patient education intervention enhanced with positive-affect induction and self-affirmation (PA) was more effective than patient education (PE) alone in improving medication adherence and BP reduction among 256 hypertensive African Americans followed up in 2 primary care practices. Patients in both groups received a culturally tailored hypertension self-management workbook, a behavioral contract, and bimonthly telephone calls designed to help them overcome barriers to medication adherence. Also, patients in the PA group received small gifts and bimonthly telephone calls to help them incorporate positive thoughts into their daily routine and foster self-affirmation. The main outcome measures were medication adherence (assessed with electronic pill monitors) and within-patient change in BP from baseline to 12 months.Results 
                  The baseline characteristics were similar in both groups: the mean BP was 137/82 mm Hg; 36% of the patients had diabetes; 11% had stroke; and 3% had chronic kidney disease. Based on the intention-to-treat principle, medication adherence at 12 months was higher in the PA group than in the PE group (42% vs 36%, respectively; P  = .049). The within-group reduction in systolic BP (2.14 mm Hg vs 2.18 mm Hg; P  = .98) and diastolic BP (−1.59 mm Hg vs −0.78 mm Hg; P = .45) for the PA group and PE group, respectively, was not significant.Conclusions 
                  A PE intervention enhanced with PA led to significantly higher medication adherence compared with PE alone in hypertensive African Americans. Future studies should assess the cost-effectiveness of integrating such interventions into primary care.Trial Registration 
                  clinicaltrials.gov Identifier: NCT00227175
SN  - 0003-9926
M3  - doi: 10.1001/archinternmed.2011.1307
UR  - http://dx.doi.org/10.1001/archinternmed.2011.1307
ER  -