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Medication Compliance in the African American Patient with Hypertension
by Sharon Petgrave, M.S.N., R.N. Minority Nurse Writer
Hypertension is a major health concern for African Americans. They develop high blood pressure more often and at an earlier age than other ethnicities, including Caucasians and Mexican Americans. The Centers for Disease Control and Prevention (CDC) reports that more African American women than men are affected by hypertension.1 According to Demede et al., African American adults have the highest rate (44%) of hypertension in the world and are more resistant to treatment.2 Hypertension is often called "the silent killer" because there are no symptoms, so it frequently isn't detected until routine medical visits. The only way to know if one's blood pressure is high is to have it checked regularly.
Compounding these problems, noncompliance to antihypertensive medication in African Americans is common and leads to complications like strokes, heart attack, heart failure, and chronic kidney disease. These complications affect African Americans at alarming rates. Noncompliance can be intentional or unintentional, but the causes tend to remain the same. Lack of knowledge, misconceptions about the disease, heath beliefs, and education level are all factors that can affect medication compliance. Noncompliance often occurs because patients are unaware of the consequences of failing to take their medication as prescribed or are unable to afford the cost of the medication. Patients frequently report that they feel fi ne, which leads them to believe they no longer need their medication. But in reality, they need to continue taking it consistently, even when their symptoms don't exist.
Not so surprisingly, patients often associate the idea of "feeling better" as an expected result of taking their prescribed medication. Therefore, the patient will stop taking the antihypertensive medication because they do not experience any improvement. Side effects also play an important role towards noncompliance, while many patients are simply unable to afford the medication. For some, there is no other choice but to feed their families and pay rent, especially when they don't see any improvements in their health.
Health care professionals often fail to remind patients of the importance of continuing to take their medication, even when their blood pressure is normal and they feel fine. Explaining a medication's side effects is also essential so patients will not become alarmed if they experience any—often resulting in patients discontinuing the use of their medication. Many patients have reported that they stopped taking their blood pressure medication because their health care team has repeatedly told them their blood pressure is fine, so they didn't feel the need to continue the medication.
Odedosu et al. agreed that emphasis should be on patient education, particularly addressing misconceptions about hypertension and promoting adherence to antihypertensive therapy.3 In teaching patients how to manage their disease and how to be compliant with their medications, clinicians need to go much further than just reminding patients of the ramification of not taking medication as prescribed. Reminding patients to take their prescriptions— even though their blood pressure is normal—should be part of the conversation at all visits. Interventions specific to each patient must be addressed and include the following: patient education, behavioral counseling, lifestyle modification, and home self-monitoring. It's in the hands of health professionals to educate African American and other minority patients as much as possible on the medications themselves and the necessary reasons for continuing to take them.
M. Demede, A. Pandey, L. Innasimuthu, G. Jean-Louis, S.I. McFarlane, and G. Ogedegbe, "Management of hypertension in high-risk ethnic minority with heart failure," International Journal of Hypertension, (2011), 1-8, doi: 10.4061/2011/417594.
T. Odedosu, A. Schoenthaler, D.L. Vieira, C. Agyemang, and G. Ogedegbe, "Overcoming barriers to hypertension control in African American," Cleveland Clinic Journal of Medicine, 79 (2012), 46-56, doi:10.3949/ccjm.79a.11068.