A 41-year-old African American man with poorly controlled hypertension: review of patient and physician factors related to hypertension treatment adherence

JAMA. 2009 Mar 25;301(12):1260-72. doi: 10.1001/jama.2009.358. Epub 2009 Mar 3.


Mr R is an African American man with a long history of poorly controlled hypertension and difficulties with adherence to recommended treatments. Despite serious complications such as hypertensive emergency requiring hospitalization and awareness of the seriousness of his illness, Mr R says at times he has ignored his high blood pressure and his physicians' recommendations. African Americans are disproportionately affected by hypertension and its complications. Although most pharmacological and dietary therapies for hypertension are similarly efficacious for African Americans and whites, disparities in hypertension treatment persist. Like many patients, Mr R faces several barriers to effective blood pressure control: societal, health system, individual, and interactions with health professionals. Moreover, evidence indicates that patients' cognitive, affective, and attitudinal factors and the patient-physician relationship play critical roles in improving outcomes and reducing racial disparities in hypertension control.

Publication types

  • Case Reports
  • Clinical Conference
  • Research Support, N.I.H., Extramural

MeSH terms

  • Acupuncture Therapy
  • Adult
  • Antihypertensive Agents / therapeutic use
  • Black or African American*
  • Diet
  • Drug Therapy, Combination
  • Healthcare Disparities
  • Humans
  • Hypertension / ethnology*
  • Hypertension / psychology
  • Hypertension / therapy*
  • Male
  • Patient Compliance* / ethnology
  • Patient Compliance* / psychology
  • Patient Education as Topic
  • Physician-Patient Relations
  • Socioeconomic Factors


  • Antihypertensive Agents