Dr. Gbenga Ogedegbe, MD, MPH, MS, is an Associate Professor of Medicine at the NYU School of Medicine where he is working hard to find ways to lower rates of heart disease among African Americans. In this article he discusses the role that people's beliefs about high blood pressure (hypertension) as well as depression and anxiety play in their ability to lower their blood pressure.
Q: What got you interested in working with patients who have high blood pressure and heart disease?
A: I had one patient, an 86-year-old African American man, who would come into the clinic where I worked every other month. Each time he came in, I would sit him down and talk to him about giving him medications to lower his high blood pressure (hypertension). He would tell me over and over again, "Listen son, I am 86 years old, so I must be doing something right! I don't believe in taking medications-I don't think that they work." So I finally asked him, "Well if you don't believe in medications, why do you keep coming to me?" He responded, "Because I like you and I like to see my docs... maybe there is something else wrong with my health, but it's not because of my high blood pressure."
This experience made me realize that not everyone views high blood pressure (hypertension) as a threat or a serious problem. It led me to begin focusing my work and research on how the beliefs that African Americans have about high blood pressure influence whether or not they take (and continue to take) their blood pressure medication.
Q: In general, do you find that your patients are taking their blood pressure medications the way that they should be?
A: In general, yes. However, we are finding that a lot of folks have depression, which can make it difficult for them to do many things that are good for their health, including taking medications to lower their blood pressure. As doctors, it's important to treat the person's depression first. If we don't, then we can give the patient all the medicine in the world, but they just won't take it as it needs to be taken.
There are also some people who are really anxious about taking their medication. If someone feels anxious about taking their medication, they should try going to a local community health center. The beauty of community health centers is that the workers also live in the patient's neighborhood, so patients trust and feel connected to them, which makes them more willing to take their advice.
Q: What do you do to help your hypertensive patients who also have depression and/or anxiety?
A: Two things that we've done with our patients are "positive affect induction" and "self affirmation induction." "Positive affect induction" is when rewards or small unexpected gifts are given to patients for taking their blood pressure medication. I have found that receiving small rewards, even something as small as a mug worth only three dollars, is enough to get patients to take their medications.
"Self-affirmation induction" is when we ask our patients to think about the things that make them happy-the moments in their lives that make them proud of who they are, such as their children, friends, work, etc., and use these things to motivate them to take their medication and take steps to lower their blood pressure and live healthier lives. Both of these things seem to help.