Difficulties in high blood pressure treatment compliance: considerations based on a qualitative study in a primary health care unit

Abstract

Introduction: High blood pressure (HBP) is a chronic disease whose control is essential for preventing long-term complications related to cardiovascular mortality and morbidity. The treatment for HBP is based on non-pharmacological and pharmacological measures. Treatment compliance is characterized by the degree of coincidence between medical orientation and patient behavior. On Primary Health Care level there are often difficulties in maintaining a systematic control over the blood pressure of hypertensive patients, probably due to the lack of treatment compliance of these patients. Objective: Assess the factors involved in the difficulty of compliance with anti-hypertensive treatment from the patients’ point of view. Methodology: Qualitative research, with open and semi structured individual interviews with 13 hypertensive adults, enrolled in the Program for Hypertensive Patients of a Primary Health Care Unit in Porto Alegre, Brazil. Results: Factors hampering treatment compliance were: a) initial asymptomatic phase; b) use of medication only when patients think their blood pressure is high (the increase is associated with symptoms patients believe to be a consequence of HBP such as headache, nausea, or when they “get nervous”); c) the idea of cure and abandonment of treatment while, in fact, their blood pressure is but under control; d) resistance in taking the medication in a systematic way, making them “dependent”; e) side effects of the drugs, such as erectile dysfunction and coughing ; f) difficulty in following a hyposodic diet, besides the fact that the relatives have to get used to it as well; g) the need for monthly appointments in order to obtain a refill of the medication at the health care unit: h) lack of free medication at the health care unit; i) some patients feel they are “slaves” of the schedule they have to follow because it is interfering with their daily routine. Conclusion: It is important that the health care professionals know the patients’ difficulties to be compliant with anti-hypertensive treatment so they can try correcting the problems together with the patient for a better control of HBP. It has to be pointed out that the trust resulting from a good doctor/patient relationship contributes greatly to a better treatment compliance of the patient.