Abstract 5131: The Healthy Habits Trials: Positive affect induction improves medication adherence in hypertensive African Americans
Poor medication adherence is a significant problem in hypertensive African Americans and leads to disproportionately higher blood pressure (BP) and poor health outcomes. This randomized controlled trial evaluated whether a patient education intervention enhanced with positive affect and self-affirmation inductions was more effective than a patient education control group in improving medication adherence and BP control among hypertensive African-Americans African-American hypertensive patients who were taking at least one antihypertensive medication and had uncontrolled BP (JNC-7 criteria) were eligible for enrollment. At baseline, all study participants received a workbook designed to improve knowledge about hypertension and support adherence behavior and bimonthly follow-up telephone calls. The intervention group received a workbook that was enhanced with positive affect and self-affirmation inductions that helped patients incorporate positive thoughts into their daily routine and focus on proud moments in their lives. The primary outcome was adherence to antihypertensive medications at 12 months (percent of days during which correct doses were taken over the number of days prescribed), assessed with electronic pill monitors; the secondary outcome was BP control rate. Of the 256 patients enrolled, 80% were women with a mean age of 58 ± 12 years. Baseline demographic and clinical characteristics were similar for the intervention and control groups; 95% of both groups had uncontrolled hypertension. Using intention-to-treat analysis, patients in the intervention group achieved greater medication adherence over 12 months (p= 0.04). Similarly, the proportion of patients with controlled blood pressure at 12 months was greater in the intervention group compared to the control group (59% versus 34%, p=.02). A behavioral intervention enhanced with positive affect and self-affirmation resulted in significantly greater medication adherence and blood pressure control in hypertensive African Americans compared to patient education alone. Future studies should assess the integration of such enhanced intervention into primary care practice.