Objectives: Blood pressure control is important for reducing the risk of diseases related to arteriosclerosis. However, medication non-adherence by patients is a constant challenge for health care practitioners. To understand the complexity of medication non-adherence, qualitative evaluation of patient perspectives on prescribed medications is being undertaken worldwide, but such studies are scarce in Japan. This study attempted to investigate qualitatively the perspectives of patients with high blood pressure on antihypertensive drugs.
Methods: Medical consultations were observed and qualitative interviews with patients were conducted in the following two clinical settings: medical consultations for cardiovascular diseases (n=82; 47 males, 35 females; age, 68 ± 11 years) and consultations for Kampo medicine (n=31; 18 males, 13 females; age, 72 ± 8 years). The narratives were categorized, and the reasons for medication non-adherence were determined using a cultural anthropological method.
Results: The narratives were categorized into the following 5 types: (1) willingness to take drugs because of concern about hypertension, (2) taking drugs as prescribed, but without interest in blood pressure changes, (3) no hesitation in taking antihypertensive drugs despite adverse side effects experienced after taking these drugs, (4) taking antihypertensive drugs and objectively describing how blood pressure changed on a daily basis, and (5) taking antihypertensive drugs while having concern about future side effects, or not wanting to take antihypertensive drugs. Furthermore, the concern over medications and medication non-adherence shown in (5) were attributed to a combination of the following 4 reasons: (1) prior experience in medical care, (2) physical sensations, (3) political and economic reasons, (4) a negative opinion toward modern medicine, and (5) the description of side effects listed on package inserts.
Conclusion: Most patients take antihypertensive drugs because they consider the drugs to be essential for their health. However, some patients are concerned about or reject the medications. If such concern or rejection is not based on medical reason, understanding the patients' views from their sociocultural, political, and economic perspectives is important to improve adherence.