The Multicenter Randomized HYpertension and VALUEs (HYVALUE) Trial

One in 3 US adults has hypertension and African Americans are disproportionately affected;
almost 40% of non-Hispanic blacks have hypertension. Although the rates of uncontrolled
hypertension have been decreasing in all groups, African Americans continue to have higher
rates of uncontrolled hypertension compared to white Americans. The Institute of Medicine,
World Health Organization and others have identified poor adherence to medications as the
most significant, modifiable contributor to uncontrolled hypertension.

Stereotype threat may contribute to low adherence. Stereotype threat occurs when cues in the
environment (such as visiting a doctor's office) trigger the threat of confirming, as
self-characteristic, a negative stereotype about one's group. Although any individual may
experience stereotype threat, African Americans are at greater risk due to widespread racism
and past experiences of discrimination.

Values affirmation interventions reduce stereotype threat and decrease racial disparities in
various outcomes. Values affirmation exercises typically ask participants to write a few
sentences about their core values. By focusing on values that are important to them, values
affirmation bolsters a person's self-concept by helping them view themselves as adequate,
effective, and able to control important outcomes in spite of a possible threat.

Based on the evidence supporting the effectiveness of values affirmation in educational and
other settings, the investigators hypothesize that values affirmation can similarly reduce
racial disparities in medication adherence and subsequent health outcomes. By asking
participating intervention patients to engage in a values affirmation exercise at an initial
appointment with a primary care provider, the investigators hope to improve hypertensive
medication adherence, systolic blood pressure, time under blood pressure control, and
treatment intensification, and to reduce racial disparities in these outcomes.

Inclusion Criteria:

- Hypertension diagnosis: primary or secondary ICD-10 code diagnosis in last 24 mo

- SBP >140 mm Hg or DBP >90 mm Hg in last 12 months

- Currently taking antihypertensive medications

- Medications filled within health system's pharmacy

- White or African American, self-reported race

- Upcoming primary care visit

- Ability to read and write English

Exclusion Criteria:

- Pregnancy-related hypertension

- Dialysis-dependent end-stage renal disease

- Prisoners

- Unable to provide consent