Skip to main content
PMC home page
Journal of the National Medical Association logoLink to Journal of the National Medical Association
. 2002 Apr;94(4):236–248.

A model of psychosocial and cultural antecedents of blood pressure control.

Hayden B Bosworth 1, Eugene Z Oddone 1
PMCID: PMC2594228  PMID: 11991336

Abstract

Hypertension is a major modifiable risk factor for stroke, congestive heart failure, and end-stage renal disease. Hypertension is particularly prevalent and deadly among African Americans. Effective treatment for hypertension has been available for decades, yet only one fourth of all individuals have their blood pressure under control. Despite the potential impact of hypertension, interventions to improve control have had limited success. We present a model of how to understand antecedents of blood pressure control according to three interrelated categories: patient characteristics, social and cultural environment, and medical environment. This theoretical paper was conducted using a literature review and a model to explain psychosocial antecedents of blood pressure control is presented. We conclude that improved understanding of important antecedents of blood pressure control coupled with technological advances, such as tailored interventions, provide clinicians with a tool that may lead to improved blood pressure control. These interventions will require the involvement of clinicians and consideration of sociocultural factors to be successful.

Full text

PDF
248

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adams-Campbell L. L., Brambilla D. J., McKinlay S. M. Correlates of the prevalence of self-reported hypertension among African-American and white women. Ethn Dis. 1993 Spring;3(2):119–125. [PubMed] [Google Scholar]
  2. Ahluwalia J. S., McNagny S. E., Rask K. J. Correlates of controlled hypertension in indigent, inner-city hypertensive patients. J Gen Intern Med. 1997 Jan;12(1):7–14. doi: 10.1046/j.1525-1497.1997.12107.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Baker D. W., Parker R. M., Williams M. V., Clark W. S., Nurss J. The relationship of patient reading ability to self-reported health and use of health services. Am J Public Health. 1997 Jun;87(6):1027–1030. doi: 10.2105/ajph.87.6.1027. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bandura A., Reese L., Adams N. E. Microanalysis of action and fear arousal as a function of differential levels of perceived self-efficacy. J Pers Soc Psychol. 1982 Jul;43(1):5–21. doi: 10.1037//0022-3514.43.1.5. [DOI] [PubMed] [Google Scholar]
  5. Bandura A., Taylor C. B., Williams S. L., Mefford I. N., Barchas J. D. Catecholamine secretion as a function of perceived coping self-efficacy. J Consult Clin Psychol. 1985 Jun;53(3):406–414. doi: 10.1037//0022-006x.53.3.406. [DOI] [PubMed] [Google Scholar]
  6. Barefoot J. C., Helms M. J., Mark D. B., Blumenthal J. A., Califf R. M., Haney T. L., O'Connor C. M., Siegler I. C., Williams R. B. Depression and long-term mortality risk in patients with coronary artery disease. Am J Cardiol. 1996 Sep 15;78(6):613–617. doi: 10.1016/s0002-9149(96)00380-3. [DOI] [PubMed] [Google Scholar]
  7. Becker M. H., Maiman L. A. Sociobehavioral determinants of compliance with health and medical care recommendations. Med Care. 1975 Jan;13(1):10–24. doi: 10.1097/00005650-197501000-00002. [DOI] [PubMed] [Google Scholar]
  8. Berlowitz D. R., Ash A. S., Hickey E. C., Friedman R. H., Glickman M., Kader B., Moskowitz M. A. Inadequate management of blood pressure in a hypertensive population. N Engl J Med. 1998 Dec 31;339(27):1957–1963. doi: 10.1056/NEJM199812313392701. [DOI] [PubMed] [Google Scholar]
  9. Black D. M., Brand R. J., Greenlick M., Hughes G., Smith J. Compliance to treatment for hypertension in elderly patients: the SHEP pilot study. Systolic Hypertension in the Elderly Program. J Gerontol. 1987 Sep;42(5):552–557. doi: 10.1093/geronj/42.5.552. [DOI] [PubMed] [Google Scholar]
  10. Blair S. N., Goodyear N. N., Gibbons L. W., Cooper K. H. Physical fitness and incidence of hypertension in healthy normotensive men and women. JAMA. 1984 Jul 27;252(4):487–490. [PubMed] [Google Scholar]
  11. Burke L. E., Dunbar-Jacob J. M., Hill M. N. Compliance with cardiovascular disease prevention strategies: a review of the research. Ann Behav Med. 1997 Summer;19(3):239–263. doi: 10.1007/BF02892289. [DOI] [PubMed] [Google Scholar]
  12. Burt V. L., Whelton P., Roccella E. J., Brown C., Cutler J. A., Higgins M., Horan M. J., Labarthe D. Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988-1991. Hypertension. 1995 Mar;25(3):305–313. doi: 10.1161/01.hyp.25.3.305. [DOI] [PubMed] [Google Scholar]
  13. Campbell M. K., DeVellis B. M., Strecher V. J., Ammerman A. S., DeVellis R. F., Sandler R. S. Improving dietary behavior: the effectiveness of tailored messages in primary care settings. Am J Public Health. 1994 May;84(5):783–787. doi: 10.2105/ajph.84.5.783. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Col N., Fanale J. E., Kronholm P. The role of medication noncompliance and adverse drug reactions in hospitalizations of the elderly. Arch Intern Med. 1990 Apr;150(4):841–845. [PubMed] [Google Scholar]
  15. Colhoun H. M., Hemingway H., Poulter N. R. Socio-economic status and blood pressure: an overview analysis. J Hum Hypertens. 1998 Feb;12(2):91–110. doi: 10.1038/sj.jhh.1000558. [DOI] [PubMed] [Google Scholar]
  16. Cooper-Patrick L., Gallo J. J., Gonzales J. J., Vu H. T., Powe N. R., Nelson C., Ford D. E. Race, gender, and partnership in the patient-physician relationship. JAMA. 1999 Aug 11;282(6):583–589. doi: 10.1001/jama.282.6.583. [DOI] [PubMed] [Google Scholar]
  17. Croog S. H., Shapiro D. S., Levine S. Denial among male heart patients. An empirical study. Psychosom Med. 1971 Sep-Oct;33(5):385–397. doi: 10.1097/00006842-197109000-00001. [DOI] [PubMed] [Google Scholar]
  18. DiMatteo M. R. Enhancing patient adherence to medical recommendations. JAMA. 1994 Jan 5;271(1):79–83. doi: 10.1001/jama.271.1.79. [DOI] [PubMed] [Google Scholar]
  19. DiMatteo M. R., Lepper H. S., Croghan T. W. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000 Jul 24;160(14):2101–2107. doi: 10.1001/archinte.160.14.2101. [DOI] [PubMed] [Google Scholar]
  20. Donovan J. L., Blake D. R. Patient non-compliance: deviance or reasoned decision-making? Soc Sci Med. 1992 Mar;34(5):507–513. doi: 10.1016/0277-9536(92)90206-6. [DOI] [PubMed] [Google Scholar]
  21. Eisen S. A., Miller D. K., Woodward R. S., Spitznagel E., Przybeck T. R. The effect of prescribed daily dose frequency on patient medication compliance. Arch Intern Med. 1990 Sep;150(9):1881–1884. [PubMed] [Google Scholar]
  22. Eraker S. A., Kirscht J. P., Becker M. H. Understanding and improving patient compliance. Ann Intern Med. 1984 Feb;100(2):258–268. doi: 10.7326/0003-4819-100-2-258. [DOI] [PubMed] [Google Scholar]
  23. Farmer M. E., Kittner S. J., Abbott R. D., Wolz M. M., Wolf P. A., White L. R. Longitudinally measured blood pressure, antihypertensive medication use, and cognitive performance: the Framingham Study. J Clin Epidemiol. 1990;43(5):475–480. doi: 10.1016/0895-4356(90)90136-d. [DOI] [PubMed] [Google Scholar]
  24. Fleece L., Summers M. A., Schnaper H., Wilken L. O., Jr, Yang S., Bradley E. A. Adherence to pharmacotherapeutic regimen. Assessment and intervention. Ala J Med Sci. 1988 Oct;25(4):389–393. [PubMed] [Google Scholar]
  25. Fogari R., Zoppi A., Corradi L., Mugellini A., Poletti L., Lusardi P. Sexual function in hypertensive males treated with lisinopril or atenolol: a cross-over study. Am J Hypertens. 1998 Oct;11(10):1244–1247. doi: 10.1016/s0895-7061(98)00139-3. [DOI] [PubMed] [Google Scholar]
  26. Folkman S., Chesney M., Pollack L., Coates T. Stress, control, coping, and depressive mood in human immunodeficiency virus-positive and -negative gay men in San Francisco. J Nerv Ment Dis. 1993 Jul;181(7):409–416. doi: 10.1097/00005053-199307000-00002. [DOI] [PubMed] [Google Scholar]
  27. Frasure-Smith N., Lespérance F., Talajic M. Depression following myocardial infarction. Impact on 6-month survival. JAMA. 1993 Oct 20;270(15):1819–1825. [PubMed] [Google Scholar]
  28. Fulde E., Junge A., Ahrens S. Coping strategies and defense mechanisms and their relevance for the recovery after discectomy. J Psychosom Res. 1995 Oct;39(7):819–826. doi: 10.1016/0022-3999(95)00014-6. [DOI] [PubMed] [Google Scholar]
  29. Gerin W., Litt M. D., Deich J., Pickering T. G. Self-efficacy as a moderator of perceived control effects on cardiovascular reactivity: is enhanced control always beneficial? Psychosom Med. 1995 Jul-Aug;57(4):390–397. doi: 10.1097/00006842-199507000-00011. [DOI] [PubMed] [Google Scholar]
  30. Gueyffier F., Boutitie F., Boissel J. P., Pocock S., Coope J., Cutler J., Ekbom T., Fagard R., Friedman L., Perry M. Effect of antihypertensive drug treatment on cardiovascular outcomes in women and men. A meta-analysis of individual patient data from randomized, controlled trials. The INDANA Investigators. Ann Intern Med. 1997 May 15;126(10):761–767. doi: 10.7326/0003-4819-126-10-199705150-00002. [DOI] [PubMed] [Google Scholar]
  31. Hall J. A., Roter D. L., Katz N. R. Meta-analysis of correlates of provider behavior in medical encounters. Med Care. 1988 Jul;26(7):657–675. doi: 10.1097/00005650-198807000-00002. [DOI] [PubMed] [Google Scholar]
  32. Hall W. D., Ferrario C. M., Moore M. A., Hall J. E., Flack J. M., Cooper W., Simmons J. D., Egan B. M., Lackland D. T., Perry M., Jr Hypertension-related morbidity and mortality in the southeastern United States. Am J Med Sci. 1997 Apr;313(4):195–209. doi: 10.1097/00000441-199704000-00002. [DOI] [PubMed] [Google Scholar]
  33. Hill M. N., Bone L. R., Kim M. T., Miller D. J., Dennison C. R., Levine D. M. Barriers to hypertension care and control in young urban black men. Am J Hypertens. 1999 Oct;12(10 Pt 1):951–958. doi: 10.1016/s0895-7061(99)00121-1. [DOI] [PubMed] [Google Scholar]
  34. Hyman D. J., Pavlik V. N., Vallbona C., Dunn J. K., Louis K., Dewey C. M., Wieck L. Blood pressure measurement and antihypertensive treatment in a low-income African-American population. Am J Public Health. 1998 Feb;88(2):292–294. doi: 10.2105/ajph.88.2.292. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Joos S. K., Hickam D. H., Gordon G. H., Baker L. H. Effects of a physician communication intervention on patient care outcomes. J Gen Intern Med. 1996 Mar;11(3):147–155. doi: 10.1007/BF02600266. [DOI] [PubMed] [Google Scholar]
  36. Kamarck T. W., Manuck S. B., Jennings J. R. Social support reduces cardiovascular reactivity to psychological challenge: a laboratory model. Psychosom Med. 1990 Jan-Feb;52(1):42–58. doi: 10.1097/00006842-199001000-00004. [DOI] [PubMed] [Google Scholar]
  37. Kaplan G. A., Keil J. E. Socioeconomic factors and cardiovascular disease: a review of the literature. Circulation. 1993 Oct;88(4 Pt 1):1973–1998. doi: 10.1161/01.cir.88.4.1973. [DOI] [PubMed] [Google Scholar]
  38. Kravitz R. L., Hays R. D., Sherbourne C. D., DiMatteo M. R., Rogers W. H., Ordway L., Greenfield S. Recall of recommendations and adherence to advice among patients with chronic medical conditions. Arch Intern Med. 1993 Aug 23;153(16):1869–1878. [PubMed] [Google Scholar]
  39. Krieger N. Racial and gender discrimination: risk factors for high blood pressure? Soc Sci Med. 1990;30(12):1273–1281. doi: 10.1016/0277-9536(90)90307-e. [DOI] [PubMed] [Google Scholar]
  40. Krieger N., Sidney S. Racial discrimination and blood pressure: the CARDIA Study of young black and white adults. Am J Public Health. 1996 Oct;86(10):1370–1378. doi: 10.2105/ajph.86.10.1370. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Levy D., Larson M. G., Vasan R. S., Kannel W. B., Ho K. K. The progression from hypertension to congestive heart failure. JAMA. 1996 May 22;275(20):1557–1562. [PubMed] [Google Scholar]
  42. Ley P. Memory for medical information. Br J Soc Clin Psychol. 1979 Jun;18(2):245–255. doi: 10.1111/j.2044-8260.1979.tb00333.x. [DOI] [PubMed] [Google Scholar]
  43. McLoyd V. C. The impact of economic hardship on black families and children: psychological distress, parenting, and socioemotional development. Child Dev. 1990 Apr;61(2):311–346. doi: 10.1111/j.1467-8624.1990.tb02781.x. [DOI] [PubMed] [Google Scholar]
  44. Mechanic D., Schlesinger M. The impact of managed care on patients' trust in medical care and their physicians. JAMA. 1996 Jun 5;275(21):1693–1697. [PubMed] [Google Scholar]
  45. Miller N. H., Hill M., Kottke T., Ockene I. S. The multilevel compliance challenge: recommendations for a call to action. A statement for healthcare professionals. Circulation. 1997 Feb 18;95(4):1085–1090. doi: 10.1161/01.cir.95.4.1085. [DOI] [PubMed] [Google Scholar]
  46. Moy E., Bartman B. A., Weir M. R. Access to hypertensive care. Effects of income, insurance, and source of care. Arch Intern Med. 1995 Jul 24;155(14):1497–1502. [PubMed] [Google Scholar]
  47. Mullen P. D., Mains D. A., Velez R. A meta-analysis of controlled trials of cardiac patient education. Patient Educ Couns. 1992 Apr;19(2):143–162. doi: 10.1016/0738-3991(92)90194-n. [DOI] [PubMed] [Google Scholar]
  48. Nagy V. T., Wolfe G. R. Cognitive predictors of compliance in chronic disease patients. Med Care. 1984 Oct;22(10):912–921. doi: 10.1097/00005650-198410000-00004. [DOI] [PubMed] [Google Scholar]
  49. Neaton J. D., Grimm R. H., Jr, Prineas R. J., Stamler J., Grandits G. A., Elmer P. J., Cutler J. A., Flack J. M., Schoenberger J. A., McDonald R. Treatment of Mild Hypertension Study. Final results. Treatment of Mild Hypertension Study Research Group. JAMA. 1993 Aug 11;270(6):713–724. [PubMed] [Google Scholar]
  50. Ooi W. L., Budner N. S., Cohen H., Madhavan S., Alderman M. H. Impact of race on treatment response and cardiovascular disease among hypertensives. Hypertension. 1989 Sep;14(3):227–234. doi: 10.1161/01.hyp.14.3.227. [DOI] [PubMed] [Google Scholar]
  51. Parker R. M., Baker D. W., Williams M. V., Nurss J. R. The test of functional health literacy in adults: a new instrument for measuring patients' literacy skills. J Gen Intern Med. 1995 Oct;10(10):537–541. doi: 10.1007/BF02640361. [DOI] [PubMed] [Google Scholar]
  52. Perry H. M., Roccella E. J. Conference report on stroke mortality in the southeastern United States. Hypertension. 1998 Jun;31(6):1206–1215. doi: 10.1161/01.hyp.31.6.1206. [DOI] [PubMed] [Google Scholar]
  53. Prochaska J. O., DiClemente C. C., Velicer W. F., Rossi J. S. Standardized, individualized, interactive, and personalized self-help programs for smoking cessation. Health Psychol. 1993 Sep;12(5):399–405. doi: 10.1037//0278-6133.12.5.399. [DOI] [PubMed] [Google Scholar]
  54. Rahman M., Douglas J. G., Wright J. T., Jr Pathophysiology and treatment implications of hypertension in the African-American population. Endocrinol Metab Clin North Am. 1997 Mar;26(1):125–144. doi: 10.1016/s0889-8529(05)70237-1. [DOI] [PubMed] [Google Scholar]
  55. Rimer B. K., Glassman B. Tailoring communications for primary care settings. Methods Inf Med. 1998 Jun;37(2):171–177. [PubMed] [Google Scholar]
  56. Rosenstock I. M. Enhancing patient compliance with health recommendations. J Pediatr Health Care. 1988 Mar-Apr;2(2):67–72. doi: 10.1016/0891-5245(88)90169-1. [DOI] [PubMed] [Google Scholar]
  57. Rost K., Roter D. Predictors of recall of medication regimens and recommendations for lifestyle change in elderly patients. Gerontologist. 1987 Aug;27(4):510–515. doi: 10.1093/geront/27.4.510. [DOI] [PubMed] [Google Scholar]
  58. Roter D. L., Hall J. A., Merisca R., Nordstrom B., Cretin D., Svarstad B. Effectiveness of interventions to improve patient compliance: a meta-analysis. Med Care. 1998 Aug;36(8):1138–1161. doi: 10.1097/00005650-199808000-00004. [DOI] [PubMed] [Google Scholar]
  59. Shea S., Misra D., Ehrlich M. H., Field L., Francis C. K. Predisposing factors for severe, uncontrolled hypertension in an inner-city minority population. N Engl J Med. 1992 Sep 10;327(11):776–781. doi: 10.1056/NEJM199209103271107. [DOI] [PubMed] [Google Scholar]
  60. Sherbourne C. D., Hays R. D., Ordway L., DiMatteo M. R., Kravitz R. L. Antecedents of adherence to medical recommendations: results from the Medical Outcomes Study. J Behav Med. 1992 Oct;15(5):447–468. doi: 10.1007/BF00844941. [DOI] [PubMed] [Google Scholar]
  61. Shulman N., Cutter G., Daugherty R., Sexton M., Pauk G., Taylor M. J., Tyler M. Correlates of attendance and compliance in the hypertension detection and follow-up program. Control Clin Trials. 1982 Mar;3(1):13–27. doi: 10.1016/0197-2456(82)90016-2. [DOI] [PubMed] [Google Scholar]
  62. Skinner C. S., Strecher V. J., Hospers H. Physicians' recommendations for mammography: do tailored messages make a difference? Am J Public Health. 1994 Jan;84(1):43–49. doi: 10.2105/ajph.84.1.43. [DOI] [PMC free article] [PubMed] [Google Scholar]
  63. Sleath B., Roter D., Chewning B., Svarstad B. Asking questions about medication: analysis of physician-patient interactions and physician perceptions. Med Care. 1999 Nov;37(11):1169–1173. doi: 10.1097/00005650-199911000-00009. [DOI] [PubMed] [Google Scholar]
  64. Stanton A. L. Determinants of adherence to medical regimens by hypertensive patients. J Behav Med. 1987 Aug;10(4):377–394. doi: 10.1007/BF00846477. [DOI] [PubMed] [Google Scholar]
  65. Stason W. B., Shepard D. S., Perry H. M., Jr, Carmen B. M., Nagurney J. T., Rosner B., Meyer G. Effectiveness and costs of veterans affairs hypertension clinics. Med Care. 1994 Dec;32(12):1197–1215. doi: 10.1097/00005650-199412000-00004. [DOI] [PubMed] [Google Scholar]
  66. Strecher V. J., DeVellis B. M., Becker M. H., Rosenstock I. M. The role of self-efficacy in achieving health behavior change. Health Educ Q. 1986 Spring;13(1):73–92. doi: 10.1177/109019818601300108. [DOI] [PubMed] [Google Scholar]
  67. Strecher V. J., Kreuter M., Den Boer D. J., Kobrin S., Hospers H. J., Skinner C. S. The effects of computer-tailored smoking cessation messages in family practice settings. J Fam Pract. 1994 Sep;39(3):262–270. [PubMed] [Google Scholar]
  68. Strogatz D. S., Croft J. B., James S. A., Keenan N. L., Browning S. R., Garrett J. M., Curtis A. B. Social support, stress, and blood pressure in black adults. Epidemiology. 1997 Sep;8(5):482–487. doi: 10.1097/00001648-199709000-00002. [DOI] [PubMed] [Google Scholar]
  69. Suls J., Fletcher B. The relative efficacy of avoidant and nonavoidant coping strategies: a meta-analysis. Health Psychol. 1985;4(3):249–288. doi: 10.1037//0278-6133.4.3.249. [DOI] [PubMed] [Google Scholar]
  70. Thom D. H., Campbell B. Patient-physician trust: an exploratory study. J Fam Pract. 1997 Feb;44(2):169–176. [PubMed] [Google Scholar]
  71. Trevino D. B., Young E. H., Groff J., Jono R. T. The association between marital adjustment and compliance with antihypertension regimens. J Am Board Fam Pract. 1990 Jan-Mar;3(1):17–25. [PubMed] [Google Scholar]
  72. Weiss B. D., Hart G., McGee D. L., D'Estelle S. Health status of illiterate adults: relation between literacy and health status among persons with low literacy skills. J Am Board Fam Pract. 1992 May-Jun;5(3):257–264. [PubMed] [Google Scholar]
  73. Williams G. C., Freedman Z. R., Deci E. L. Supporting autonomy to motivate patients with diabetes for glucose control. Diabetes Care. 1998 Oct;21(10):1644–1651. doi: 10.2337/diacare.21.10.1644. [DOI] [PubMed] [Google Scholar]
  74. Williams G. C., Rodin G. C., Ryan R. M., Grolnick W. S., Deci E. L. Autonomous regulation and long-term medication adherence in adult outpatients. Health Psychol. 1998 May;17(3):269–276. doi: 10.1037//0278-6133.17.3.269. [DOI] [PubMed] [Google Scholar]
  75. Williams M. V., Baker D. W., Parker R. M., Nurss J. R. Relationship of functional health literacy to patients' knowledge of their chronic disease. A study of patients with hypertension and diabetes. Arch Intern Med. 1998 Jan 26;158(2):166–172. doi: 10.1001/archinte.158.2.166. [DOI] [PubMed] [Google Scholar]
  76. Williams M. V., Parker R. M., Baker D. W., Parikh N. S., Pitkin K., Coates W. C., Nurss J. R. Inadequate functional health literacy among patients at two public hospitals. JAMA. 1995 Dec 6;274(21):1677–1682. [PubMed] [Google Scholar]
  77. Williams R. B., Barefoot J. C., Califf R. M., Haney T. L., Saunders W. B., Pryor D. B., Hlatky M. A., Siegler I. C., Mark D. B. Prognostic importance of social and economic resources among medically treated patients with angiographically documented coronary artery disease. JAMA. 1992 Jan 22;267(4):520–524. [PubMed] [Google Scholar]

Articles from Journal of the National Medical Association are provided here courtesy of National Medical Association

RESOURCES