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The Relationship Among Health Beliefs, Depressive Symptoms, Medication Adherence, and Social Support in African Americans With Hypertension

Spikes, Telisa, MSN, RN; Higgins, Melinda, PhD; Quyyumi, Arshed, MD, FACC, FRCP; Reilly, Carolyn, PhD, RN, CHFN, FAHA; Pemu, Pricilla, MD, MSCR, FACP; Dunbar, Sandra, PhD, RN, FAAN, FAHA, FPCNA

doi: 10.1097/JCN.0000000000000519
ARTICLES: Depression

Background: African Americans are disproportionately affected by hypertension and have lower medication adherence when compared to other racial groups. Antecedent factors such as beliefs surrounding hypertension, the presence or absence of social support, and depressive symptoms have not been extensively studied collectively in relation to hypertension medication adherence in African Americans.

Objective: To determine the associations among demographic and clinical factors, depressive symptoms, hypertension beliefs, and social support with blood pressure medication adherence in middle-aged African American adults with a diagnosis of hypertension.

Methods: A cross-sectional study of (N = 120) African Americans (mean age, 49 years; 22.5% men) with a current diagnosis of metabolic syndrome, including hypertension, who reported having and taking a prescribed blood pressure–lowering medication were included. Descriptive statistics, bivariate correlation analysis, and logistic regression using odds ratio were used to examine the effects of high blood pressure beliefs, social support, and depression on medication adherence.

Results: A small but significant relationship was found between medication adherence and number of comorbidities (r = 0.19, P = .04). In a multivariate regression model, after controlling for gender, comorbidities remained associated with medication adherence (β = 0. 77, P = .04). Depressive symptoms, high blood pressure beliefs, and social support did not have a significant relationship with medication adherence.

Conclusions: Multiple comorbidities may have a positive impact upon medication adherence. Further study is needed in a larger sample of African Americans who have a diagnosis of hypertension in addition to other comorbidities requiring medication management.

Telisa Spikes, MSN, RN Predoctoral Fellow, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.

Melinda Higgins, PhD Associate Research Professor, Biostatistics, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.

Arshed Quyyumi, MD, FACC, FRCP Professor of Medicine, Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University, Atlanta, Georgia.

Carolyn Reilly, PhD, RN, CHFN, FAHA Associate Clinical Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.

Pricilla Pemu, MD, MSCR, FACP Professor, Morehouse School of Medicine, Atlanta, Georgia.

Sandra Dunbar, PhD, RN, FAAN, FAHA, FPCNA Professor and Associate Dean for Academic Advancement, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.

This study was supported by the National Heart, Lung, and Blood Institute (NIH; 1 U01 HL079156-01; Dr Quyyumi, PI); PHS Grant UL1 RR025008 from the Clinical and Translational Science Award program, NIH, NCRR; and grant 5P20RR11104 from the NIH, National Center for Research Resources for the Morehouse Clinical Research Center. Effort for T. Spikes was funded in part by the National Institutes of Health National Institute of Nursing Research grant number T32NR012715 (PI, S. Dunbar). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

The authors have no conflicts of interest to disclose.

Correspondence Telisa Spikes, MSN, RN, Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, NE Atlanta, GA 30322-4027 (

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