A randomized controlled trial of positive-affect intervention and medication adherence in hypertensive African Americans

Arch Intern Med. 2012 Feb 27;172(4):322-6. doi: 10.1001/archinternmed.2011.1307. Epub 2012 Jan 23.


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.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Antihypertensive Agents / therapeutic use*
  • Black or African American / education
  • Black or African American / psychology
  • Blood Pressure / drug effects
  • Cognitive Behavioral Therapy / methods*
  • Disease Management
  • Female
  • Health Status Disparities
  • Humans
  • Hypertension* / drug therapy
  • Hypertension* / ethnology
  • Hypertension* / psychology
  • Male
  • Medication Adherence* / ethnology
  • Medication Adherence* / psychology
  • Middle Aged
  • Outcome and Process Assessment, Health Care
  • Patient Education as Topic / methods*
  • Primary Health Care / methods
  • Self Administration / psychology
  • Treatment Outcome


  • Antihypertensive Agents

Associated data

  • ClinicalTrials.gov/NCT00227175