Hypertension and Adherence in Rural Practice

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DESCRIPTION (provided by investigator): Hypertension (HTN) is the most prevalent, modifiable risk factor for stroke, coronary heart disease (CHD), and congestive heart failure (CHF). African-Americans and individuals with low educational and income levels are at the greatest risk for HTN-related morbidity and mortality. As few as 11 percent of HTN patients are adequately controlled, with estimates of non-adherence from 20-90 percent. This proposed 4-year project is a randomized clinical trial evaluating the effect of a theory-driven, multi-component adherence promotion intervention on medication adherence in a sample of low-income, predominantly African-American, residents of rural Alabama who are receiving pharmacologic treatment for HTN. A sample of 426 patients will be recruited from the population of patients enrolled in the ADPH HTN Management Program. Participants will be randomly assigned to one of two treatment conditions: Adherence Promotion (AP) intervention or Cancer Information (CI) control. Both conditions involve a series of home visits and follow-up phone calls conducted by a trained and experienced Community Health Advisor (CHA.). The AP treatment condition is a theory-driven, multi-component intervention utilizing interactive software to direct the CHA and participant through a semi-structured dialogue incorporating individualized assessment and tailored feedback intended to help patients develop behavior management skills that can be used to maintain consistent patterns of medication use and regular attendance at scheduled clinic appointments. The CI control condition will utilize non-interactive software to direct the CHA and participant through a semi-structured dialogue addressing general information about common cancers and standard recommendations relevant to cancer prevention and control. The primary outcome, pill counts for prescribed antihypertensive medications, will be collected at 3-, 6-, 9-, and 12-month follow-up. Patient self-reported adherence and attendance at appointments to refill prescriptions for antihypertensive medications will be examined as secondary measures of treatment adherence. A number of adherence-related measures (BP, symptoms and side effects, attitudes about HTN and medication use, depression) will also be obtained to examine theoretical constructs addressed in the development of the AP intervention and to examine patient characteristics associated with response to treatment.