Positive thoughts improve medication adherence in hypertensive patients

A positive-affect induction and self-affirmation (PA) intervention significantly increases medication adherence in hypertensive African–American patients, an analysis shows. 

Future studies should assess the cost-effectiveness of integrating such interventions into primary care, report Gbenge Ogedegbe (New York University School of Medicine, USA) and co-authors in the Archives of Internal Medicine. 

Researchers have reported similar findings in patients who have recently undergone percutaneous coronary intervention, as published in the same issue of this journal and covered by MedWire News. 

In the current study, Ogedegbe and team conducted a randomized controlled trial to evaluate whether a patient education (PE) intervention enhanced with PA was more effective than patient education alone in improving medication adherence and control of hypertension, a condition that “disproportionately affects African–Americans compared with Whites,” the authors explain. 

The trial included 256 African–American patients who had a diagnosis of hypertension, were taking at least one antihypertensive drug, and were fluent in English. Each patient was randomly assigned to either the PE control group or the PA intervention group. 

Patients in the control group received an educational workbook designed to enhance their knowledge about hypertension, improve self-management behaviors, and support goal-setting. They also received a behavioral contract which stated their commitment to take medications as prescribed, and bimonthly telephone calls during which their contract and confidence to adhere to medications was assessed. 

Patients assigned to the intervention group were given the same workbook as those in the control group with an additional chapter that addressed the benefits of thinking of positive moments to overcome obstacles to medication adherence. They also received bimonthly telephone calls during which they received two forms of PA. 

Firstly, they were asked to identify positive thoughts and incorporate these into their daily routine. Secondly they received small, unexpected gifts to induce positive feelings. For self-affirmation induction, patients were asked to remember proud moments and core values whenever they encountered difficulties in adhering to medication. 

Overall, the baseline characteristics were similar in both groups. The mean blood pressure (BP) was 137/82 mmHg, 36% of the patients had diabetes, 11% had a history of stroke, and 3% had chronic kidney disease. 

In the intention-to-treat analysis, medication adherence, assessed with electronic pill monitors, was higher in the PA group than in the PE group at 12 months, at 42% versus 36% (p=0.049), although this association was of borderline significance. 

However, the within-group reduction in systolic BP for the PA and PE groups (2.14 vs 2.18 mmHg) and diastolic BP (–1.59 vs 0.78 mmHg), respectively, was not significant. 

“The addition of PA constructs to the PE workbook may have led to greater self-efficacy and behavioral activation of patients in the PA intervention group, thus enhancing their desire and capability to adhere to prescribed antihypertensive medications,” the authors suggest. 

In a related commentary, editorialists Geoffrey Williams and Christopher Niemiec, both from the (University of Rochester in New York, USA) write of the articles on PA: “Such findings are the first (to our knowledge) to show a salubrious effect of induced positive affect on sustained behavior change in a clinical population.” 

They conclude: “We recommend that future research target positive affect and self-affirmation in a context of support for satisfaction of the basic psychological needs for autonomy, competence, and relatedness.” 

Reference: Arch Intern Med 2012; Advance online publication