EXPECTATIONS OF BLOOD PRESSURE MANAGEMENT

Posted by James

INTRODUCTION

African Americans have the highest prevalence of hypertension in the United States, and they experience higher rates of hypertension-related adverse outcomes, such as stroke and renal disease, compared to European Americans. Such high rates of hypertension-related adverse outcomes may be explained, in part, by the higher rates of uncontrolled hypertension noted in African Americans compared to European Americans. While some investigators have suggested that these racial disparities in adverse outcomes may be due to poorer medication adherence noted in African Americans compared to European Americans, others have attributed them to the lay beliefs about the meaning, causes, and treatment of hypertension in this population. The beliefs patients have may underlie how they construct their own models or understanding of their illness with such models often differing from traditional biomedical beliefs held by physicians. Such discordance may, in turn, lead to poor clinical outcomes. For example, in a clinic-based study of older hypertensive African-American women in Louisiana, Heurtin-Roberts and colleagues identified two models of hypertension—a traditional biomedical model where hypertension was perceived to be a chronic disease that requires lifelong treatment and a nonbiomedical model where hypertension was perceived to be an acute, hyperactive, nervous disease that occurs in exacerbations and frequently leads to increased pressure in the blood. The authors further demonstrated that patients with nonbiomedical models of hypertension had poorer compliance and blood pressure control compared to those with biomedical models.

What is not clear, however, is the mechanism through which these lay patient beliefs affect clinical outcomes. One potential concept that may underlie these beliefs is patients’ expectations of care. Expectations are defined as verbal or explicit communication of patients’ wishes and desires to their healthcare providers. The sources of patient expectations are often related to beliefs about their illness regarding their perceived vulnerability, transmitted knowledge, and perceived symptoms among other things. Expectations may underlie the poor outcomes seen in patients with chronic diseases. Specifically, expectations are associated with satisfaction with care, resource utilization, adherence to recommended treatment, and requests for medications and procedures. Patients whose expectations are unmet are less likely to be satisfied with their care; they are less likely to adhere to recommended treatment and medical advice; and they report poorer health-related outcomes and increased healthcare utilization than those whose expectations are met. Therefore, eliciting patients’ expectations may be an important component of clinical care in patients with chronic diseases. This may be particularly true for African Americans, given the divergence in cultural health-related beliefs of this group from traditional biomedical beliefs. cheap antibiotics

With regards to hypertension, it will be interesting to understand the nature of patients’ expectations especially as it relates to treatment. For instance, are patients’ expectations of their hypertension treatment biomedical or nonbiomedical? For the purpose of this paper, we define biomedical expectations as those that coincide with traditional notions of hypertension as a chronic, largely asymptomatic, and incurable disease that requires lifelong treatment with antihypertensive medica tions. Nonbiomedical expectations are defined as expectations that are different from the above stated traditional biomedical teachings about hypertension. Surprisingly, there is no literature on patients’ expectations of hypertension treatment in African-American patients.

The aims of this study, therefore, were to elicit and characterize the expectations of treatment in a group of hypertensive African-American patients followed in a primary care practice.
Viagra Online Canadian Pharmacy