‘People say it is dangerous’: psychosocial consequences of labelling people with mild hypertension – a qualitative study

Janos Valery  Gyuricza; John Brodersen; Lucas Bastos Marcondes Machado; Ana Flávia Pires Lucas d'Oliveira

doi:10.5712/rbmfc17(44)3052

Authors

Janos Valery Gyuricza Universidade de São Paulo, School of Medicine, Department of Preventive Medicine – São Paulo (SP), Brazil. https://orcid.org/0000-0001-7127-4541
John Brodersen Forskningsenheden for Almen Praksis, Center for Sundhed og Samfund, Københavns Universitet
Lucas B M Machado Universidade de São Paulo, School of Medicine, Family and Community Medicine Residency Program – São Paulo (SP), Brazil. https://orcid.org/0000-0003-2934-9444
Ana Flavia P L d'Oliveira Universidade de São Paulo, School of Medicine, Department of Preventive Medicine – São Paulo (SP), Brazil https://orcid.org/0000-0003-1456-4184

DOI:

https://doi.org/10.5712/rbmfc17(44)3052

Keywords:

Medical overuse, Diagnostic errors, hypertension, Models, biopsychosocial, Qualitative research.

Abstract

Introduction: Mild hypertension is a common asymptomatic condition present in people at low risk of future cardiovascular events. These people represent approximately two-thirds of those diagnosed with hypertension. The best available evidence does not support pharmacological treatment for mild hypertension to reduce cardiovascular mortality. Additionally, overdetection of hypertension also occurs, and this practice is supported by public awareness campaigns, screening, easy access to testing, and poor clinical practice, enhancing the overdiagnosis potential. Moreover, sparse qualitative patient-oriented evidence that diagnosing hypertension has harmful consequences is observed. Therefore, evidence regarding the potential for unintended psychosocial effects of diagnosing mild hypertension is required. Objective: The aim of this study was to investigate if diagnosing low-risk people with mild hypertension has unintended psychosocial consequences. Methods: Eleven semi-structured single interviews and four focus groups were conducted in São Paulo, Brazil, among people diagnosed with mild hypertension without comorbidities. Informants were selected among the general population from a list of patients, a primary healthcare clinic, or a social network. The informants had a broad range of characteristics, including sex, age, education level, race/skin colour, and time from diagnosis. Data were subjected to qualitative thematic content analysis by three of the authors independently, followed by discussions, to generate categories and themes. Results: The informants confirmed that the hypertension diagnosis was a label for psychosomatic reactions to stress, medicalised illness experiences, and set a biographical milestone. We observed unintended consequences of the diagnosis in a broad range of psychosocial dimensions, for example, fear of death, disabilities, or ageing; pressure and control from significant others; and guilt, shame, and anxiety regarding work and leisure. Although informants had a broad range of characteristics, they shared similar stories, understandings, and labelling effects of the diagnosis. Conclusion: The diagnosis of hypertension is a significant event and affects daily life. Most of the impact is regarded as negative psychosocial consequences or harm; however, sometimes the impact might be ambiguous. Patients’ explanatory models are key elements in understanding and changing the psychosocial consequences of the diagnosis, and healthcare providers must be aware of explanatory models and psychosocial consequences when evaluating blood pressure elevations.

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