Clinical Crossroads
Clinician's Corner
March 25, 2009

A 41-Year-Old African American Man With Poorly Controlled HypertensionReview of Patient and Physician Factors Related to Hypertension Treatment Adherence

Author Affiliations

Author Affiliation: Department of Medicine, Johns Hopkins University School of Medicine, and Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.

JAMA. 2009;301(12):1260-1272. doi:10.1001/jama.2009.358

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.