Hypertension is a common, chronic condition that contributes substantially to cardiovascular morbidity and mortality and resource use. Despite the proven efficacy of medications and lifestyle modification for treatment of hypertension and prevention of its complications, most adults with established hypertension are uncontrolled. Limited access to medical care and financial barriers to obtaining medications play an important role; however, even among patients who receive regular care, blood pressure control remains suboptimal. Patient nonadherence to recommended therapies and problems in physician management of patients with hypertension are critical contributors to poor quality of care and negative health outcomes of hypertension. Of particular concern is the disproportionately high prevalence and incidence of hypertension and its complications among African Americans and socioeconomically disadvantaged persons. Ethnic and social class disparities in patient adherence are frequently based on financial, logistical, environmental, and cultural barriers that, while not unique to ethnic minorities and the poor, have a greater impact on these populations. Successful features of previous interventions in these populations include the use of multifaceted and high intensity approaches, culturally targeted and linguistically appropriate methods, improved access to care, tailoring to individuals' needs, establishment of partnerships with stakeholders, and community involvement.

Research Question:
Do interventions that are designed to increase patient participation in care among inner city minorities and persons living in poverty improve patient adherence to recommended therapies for hypertension?

• Our study is a patient and physician interventions that will address the specific needs of inner city ethnic minorities and persons living in poverty who have hypertension.
• The patient intervention was an education, activation, and active follow-up intervention delivered by a trained community health worker who comes from the communities served by the clinical sites and shares important cultural and social values and experiences with patients.
• The physician intervention was a computerized, self-study communication skills training program delivered via an interactive CD-ROM with tailored feedback to address physicians' individual communication skills needs.