Disparities in hypertension and cardiovascular disease in blacks: The critical role of medication adherence

J Clin Hypertens (Greenwich). 2017 Oct;19(10):1015-1024. doi: 10.1111/jch.13089. Epub 2017 Aug 30.


Blacks are two to three times as likely as whites to die of preventable heart disease and stroke. Declines in mortality from heart disease have not eliminated racial disparities. Control and effective treatment of hypertension, a leading cause of cardiovascular disease, among blacks is less than in whites and remains a challenge. One of the driving forces behind this racial/ethnic disparity is medication nonadherence whose cause is embedded in social determinants. Eight practical approaches to addressing medication adherence with the potential to attenuate disparities were identified and include: (1) patient engagement strategies, (2) consumer-directed health care, (3) patient portals, (4) smart apps and text messages, (5) digital pillboxes, (6) pharmacist-led engagement, (7) cardiac rehabilitation, and (8) cognitive-based behavior. However, while data suggest that these strategies may improve medication adherence, the effect on ameliorating racial/ethnic disparities is not certain. This review describes the relationship between disparities and medication adherence, which likely plays a role in persistent disparities in cardiovascular morbidity and mortality.

Keywords: Adherence; Food and Drug Administration; blacks; cardiovascular disease; health disparities; hypertension; race/ethnicity.

Publication types

  • Review

MeSH terms

  • Antihypertensive Agents / therapeutic use
  • Awareness
  • Black or African American / statistics & numerical data*
  • Cardiovascular Diseases / ethnology*
  • Cardiovascular Diseases / mortality
  • Cardiovascular Diseases / prevention & control
  • Female
  • Healthcare Disparities / ethnology*
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Hypertension / complications
  • Hypertension / drug therapy*
  • Male
  • Medication Adherence / ethnology*
  • Medication Adherence / statistics & numerical data
  • Retrospective Studies
  • Social Class
  • United States / epidemiology
  • United States / ethnology
  • White People / statistics & numerical data


  • Antihypertensive Agents