EXPECTATIONS OF BLOOD PRESSURE MANAGEMENT: RESULTS

Posted by James

Table 1 outlines the demographic characteristics of the study sample. The median duration of hypertension was eight years with median hypertension treatment duration of six years. Blood pressure data were available on 81 patients, of whom 60% had uncontrolled hypertension [defined as systolic blood pressure of 140 mm hg or diastolic blood pressure of 90 mm hg]. Regarding comorbidity, most patients had no comorbid illness, 26% had diabetes, while fewer than 6% had heart disease, cerebrovascular disease, peripheral vascular disease, or renal failure.

In all, 58 different expectations were elicited, and these were grouped into a taxonomy of three major categories that were labeled as: 1) expectations regarding patient’s role in self-management, 2) expectations regarding physician’s role, and 3) expectations regarding medication effects. Patient’s role addresses what patients expect of themselves in the course of their treatment. Physician’s role addresses what patients expect their physicians to do for them in the course of their treatment. Finally, the third category, labeled medication effects, addresses what patients expect from taking their blood pressure medications. Table 2 summarizes the taxonomy of categories of patient expectations elicited from patients, along with the related concepts.

Patients’ Role

This category was cited by 27% of patients. It reflects patients’ willingness to take responsibility for their care and underscores the importance of patient empowerment and the decision-sharing aspect of patient care. Specifically, patients expected to play an active role in their care as it relates to the adoption of healthy lifestyle behaviors, such as avoiding stress, losing weight, increasing their physical activity levels, and reducing dietary fat and sodium intake. For instance, a patient said, “I plan on lowering my blood pressure through non-pharmacologic ways—through diet, reducing stress levels, exercising more, and engaging in herbal remedies.” Another patient said, “I don’t expect to take the medications all my life. I expect to lose weight, to adopt a better diet in order to stop taking medications.” Contrary to previously held beliefs, patients expressed their willingness to follow their doctors’ orders. This is captured by this statement: “It is up to me to follow the right diet and take the medication as directed.” canadian antibiotics

Physician’s Role

This category was cited by 7% of patients and reflects the functions that patients expect their physicians to perform during their care. Specifically, patients expected their blood pressure to be checked at each visit; they also expected their physicians to reduce the dose or discontinue their medications at some point during the course of their treatment, especially if their blood pressure reading was normal. One patient said, “I hope that the doctor will check my blood pressure and get me off the medication.” Some patients felt their physicians should educate them about side effects of medications, and how the medications work. One patient said, “What are the side effects of the medication, and how long will I take it for?” Other patients expected their physicians to provide them information about the duration of treatment for hypertension and its complications, thus helping to improve their knowledge of hypertension. This is captured by this quote: “I expect the doctor to follow my blood pressure, keep in touch with me, and give me some guidelines about what my blood pressure is and how to bring it down.”

Medication Effects

This was the most prevalent category. It was cited by 57% of patients and reflects patients’ understanding of how their medications work as well as their perceptions of side effects. Specifically, patients expected appropriate physiologic responses to their medications, such as blood pressure lowering and subsequent prevention of complications. The following statement captures this concept: “My expectation is that the medication will control the high blood pressure. It will prevent things from happening—heart disease and kidney problems. Possibly one will not have a stroke.” Patients also expected some psychological benefits, such as reducing the stress and worry they experience from fear of complications of hypertension, from taking their blood pressure medications. One patient said, “I expect the medication to lower my blood pressure, to make me not worry so much; to make me feel like I will live longer because it keeps my blood pressure under control.” Another said, “I expect to feel relief, knowing that my blood pressure won’t become too chronic. It will not lead to stroke if I take my medication.”

Despite having these appropriate expectations of their blood pressure medications, some felt that if they took their medications as prescribed by their physicians, then they would not have to adopt recommended lifestyle behaviors, given the perception of the difficulty in maintaining such behaviors. The following quotation captures this concept: “I want the medications to work even if I don’t exercise or watch my diet or do anything. Having a habit for many years and then having to be told to stop all that is a very hard thing to do.” buy tadacip

Prevalence of Nonbiomedical Expectations

When patients were categorized according to whether they had biomedical or nonbiomedical expectations, as shown in Table 3, 65% had at least one type of nonbiomedical expectation of their treatment, while 15% had all three types of nonbiomedical expectations. Specifically, 38% did not expect to take their medications for life, 38% expected a cure of their hypertension, while 23% took their medications only when they were having symptoms. Regarding the duration of treatment for hypertension, one patient said, “I am strong and better, and I expect the doctor to take me off the Procardia [a common blood pressure medication]. I think it is cured already; they just want me to take the pill.” Another patient said: “I will never want to take it [blood pressure medication] all my life, because I don’t want my body to be filled with medications.” Regarding cure of hypertension, a patient said, “Regarding cure, I think the blood pressure will resolve itself regardless of the medications.” Another patient said, “I don’t expect a cure for black people, because they are under a lot of stress and they take poor diet. I expect a cure for white people.” Finally, regarding whether blood pressure medications should be taken with symptoms or not, one patient said, “I use my own judgment when to take it even though the doctor wants me to take it everyday. I take it only when I feel symptoms because it causes side effects.” Another patient said, “I don’t take it everyday because I don’t need to. I take it when my blood pressure is high—only when I have symptoms.” online pharmacy no prescription