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Factors Associated With Medication Adherence in Hypertensive Blacks: A Review of the Literature

Lewis, Lisa M. PhD, RN

Journal of Cardiovascular Nursing: May/June 2012 - Volume 27 - Issue 3 - p 208–219
doi: 10.1097/JCN.0b013e318215bb8f

Background: Rates of medication adherence are low among hypertensive blacks despite numerous interventions to increase their adherence.

Purpose: The aim of the study was to conduct a systematic review of the literature to understand the factors associated with medication adherence in hypertensive blacks.

Methods: A systematic computer search of qualitative and quantitative studies that examined factors associated with medication adherence in hypertensive blacks from 1966 to 2010 was performed. Studies were excluded if medication adherence was not either the primary or secondary outcome variable.

Results: Studies (n = 18) were cross-sectional or qualitative, measured adherence via self-report, and conducted in low-income blacks. Factors that were associated with medication adherence were self-efficacy, depression, patient-provider communication, and healthcare system related.

Conclusions: Findings from existing studies should be interpreted with caution because of their methodological limitations. Longitudinal studies with heterogeneous samples of hypertensive blacks are imperative so that targeted interventions can be developed for this vulnerable population.

Clinical Implications: Even though there are methodological limitations associated with existing studies, clinicians may want to consider some of the factors that were associated with medication adherence in this systematic review as they provide care for hypertensive blacks. Given that self-efficacy and patient-provider communication are modifiable factors, they can be the focus of interventions to increase medication adherence. Finally, clinicians may want to screen their hypertensive patients for depression and treat, if necessary.

Lisa M. Lewis, PhD, RN Assistant Professor, School of Nursing, University of Pennsylvania, Philadelphia.

The author has no funding or conflicts of interest to disclose.

Correspondence Lisa M. Lewis, PhD, RN, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA 19104-6096 (

© 2012 Lippincott Williams & Wilkins, Inc.