Self-Management and Resilience Trajectories in African American Adults With Hypertension

Hypertension (HTN) rates have increased worldwide, but the most significant increase in the incidence of morbidity and mortality has been in African Americans (AA) (43% vs 27% for other U.S. population groups). Despite evidence of positive benefits from lifestyle modification (healthy diet, reduced sodium intake, increased physical activity, smoking cessation) and prescribed antihypertensive therapy (AHT) many AA with HTN do not adhere to their treatment regimens. Consistent, effective lifelong self-management is required to sustain optimal BP control and thus reduce morbidity and mortality. Self-managing HTN to a blood pressure (BP) <130/80 mm Hg presents challenges such as juggling multiple medications and health care providers, dealing with complex recommendations and treatment regimens, and coping with negative emotional states. Few studies have examined the biopsychosocial mechanisms that foster effective HTN self-management and resilience among AA living with HTN. Understanding the mechanisms that influence HTN self-management and resilience in AA holds the promise of new modifiable targets for behavior-change interventions.

This study explores the relationship among resilience precursors on hypertension (HTN) self-management behaviors, stress response, and the effects that these relationships have on health outcomes-health-related quality of life (HRQOL) and blood pressure (BP) in African Americans (AA) with HTN over a 6-month period.

Study Overview

• Status: Completed
• Conditions: Quality of Life; Hypertension; Compliance, Patient; Compliance, Treatment; Compliance, Medication; Self-Management

Detailed Description

This study identifies profiles of self-management and the resilience trajectories in AA with HTN can lead to culturally appropriate, patient-centered interventions that improve their HTN self-management, quality of life, and long-term compliance.

This study aims to:

1. Assess the association among resilience precursors (dispositional optimism and resilience, emotion regulation); stress response (physiological: cortisol, interleukins [IL-6] and psychological: depression cognitions, perceived stress); hypertension self management behaviors (self-efficacy for chronic disease management, medication adherence to antihypertensives); and health outcomes (HQROL and BP) in AA with HTN at baseline and months 3 and 6.
2. Determine if stress response mediates the relationship between resilience precursors and health outcomes over time when controlling for risk regulators.
3. Determine if self-management behaviors mediates the relationship between resilience precursors and health outcomes over time when controlling for risk regulators.
4. Identify resilience trajectory patterns and factors that influence HTN self-management behaviors over time.

• Study Type: Observational
• Enrollment (Actual): 125

Contacts and Locations

Study Locations

• United States
  • Ohio
    • Cleveland, Ohio, United States, 44106
      • University Hospitals Cleveland Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 25 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

Participants self-identify as African American, 25 years and older, who have a diagnosis of hypertension and living in the Greater Cleveland area.

Description

Inclusion Criteria:

• Self-identify as African American
• 25 years of age or older
• Diagnosed with hypertension and prescribed one antihypertensive medication
• BP >130/80 mmHg
• Have at least one additional chronic health conditions
• Able to read/understand English

Exclusion Criteria:

• Unable to give informed consent or judged to have impaired cognitive ability or severe memory
• Have experienced a major CVD event or procedure (e.g., myocardial infarction, stroke, heart surgery) within the past year

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
Resilience Study Cohort; Observational, descriptive longitudinal cohort design. See inclusion and exclusion criteria for more information

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Diastolic Blood Pressure	Measure of participants' in clinic blood pressure (average of three blood pressure readings).	Baseline - 6 months
PROMIS Global Health-10 [Health-related Quality of Life]	PROMIS Global Health-10 is divided into 2 separate components: Global Physical Health and Global Mental Health. The possible score ranges from 0 to 20 points in each component, where 0 points represent the patient's most severe state of physical and/or mental health, while 20 points represent the best possible state of physical and/or mental health. A higher score indicates better quality in domains of physical and/or mental health and functioning.	Baseline - 6 months
Systolic Blood Pressure	Measure of participants' in clinic blood pressure (average of three blood pressure readings). Defined as the Number (%) of participants who achieved Systolic Blood Pressure < 130mmHg at Baseline and 6 months.	Baseline - 6 months

Collaborators and Investigators

• Sponsor: Case Western Reserve University
• Collaborators: University Hospitals Cleveland Medical Center
• Investigators: Principal Investigator: Carolyn Still, PhD, Case Western Reserve University, School of Nursing

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2022
• Primary Completion (Actual): March 21, 2025
• Study Completion (Actual): March 21, 2025

Study Registration Dates

• First Submitted: March 9, 2022
• First Submitted That Met QC Criteria: March 24, 2022
• First Posted (Actual): April 4, 2022

Study Record Updates

• Last Update Posted (Actual): May 15, 2026
• Last Update Submitted That Met QC Criteria: April 27, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Hypertension; Self-Management; Resilience
• Additional Relevant MeSH Terms: Vascular Diseases; Cardiovascular Diseases; Behavior; Treatment Adherence and Compliance; Health Behavior; Patient Acceptance of Health Care; Hypertension; Medication Adherence; Patient Compliance
• Other Study ID Numbers: 1R21NR020489-01A1 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No