Helping Hypertensive Latinos to Improve Medication Adherence (ALMA)

• Medication adherence [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  Medication adherence will be assessed with an electronic monitoring device (EMD). Adherence is defined as the scheduling adherence metric, which is the proportion of days in which a patient takes their medication correctly divided by the total number of days that s/he is expected to take them in that period.
  
  

• Blood pressure [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  Within-patient change in blood pressure is the difference between the baseline and systolic and diastolic BP readings at 6 months
  
  

Poorly controlled hypertension (HTN) remains a significant public health problem in the US. Though the age-adjusted prevalence of HTN is similar for Latinos and whites, blood pressure (BP) is much less likely to be controlled in Latinos who receive treatment than in both blacks and whites. Inadequate BP control due to poor medication adherence may explain the worse outcomes seen in Latinos. Despite a wealth of research dedicated to developing interventions to improve medication adherence in hypertensive patients, practice-based randomized trials in Latinos are limited. To address this gap, this proposal will evaluate the effect of a practice-based adherence intervention (AI) vs. usual care (UC) on medication adherence in 148 high-risk Latino patients with uncontrolled HTN. Feedback from patient interviews and a Community Academic Advisory Board will be used to culturally adapt the AI. To facilitate translation into routine practice, the AI will be integrated into the clinic electronic medical record system, and delivered by bilingual Health Coaches. To provide a more targeted intervention, a 1-month screening phase with an electronic monitoring device (EMD) will be used to determine patient's adherence status. Only patients who are non-adherent to their antihypertensive medications (taking < 80%) at the 1-month visit will be randomly assigned to either the AI or UC group. We hypothesize that a higher proportion of patients in the AI group will be adherent to their medications, and exhibit a greater reduction in systolic and diastolic BP at 6-months. All patients will meet with Health Coaches for medication reconciliation, appointment-setting, and follow-up. Those in the UC group will receive standard HTN care as determined by their physician. Patients in the AI group will also complete a tailored adherence checklist with the Health Coach and receive individualized counseling to develop self-monitoring strategies to improve medication adherence. Sessions for the AI group will be held biweekly for the first 3 months followed by monthly sessions for the remaining 3 months (9 sessions total).The primary outcome is the proportion of adherent patients 1 month after the final intervention session, assessed with EMD. The secondary outcome is reduction in systolic and diastolic BP at 6 months assessed with a validated BP monitor. Regardless of group assignment, all outcomes will be assessed at baseline, 3, and 6 months with well-validated procedures and measures.