Medication adherence, side effects and patient-physician interaction in hypertension

Hypertension is an important risk factor for cardiovascular disease, the incidence of which it is possible to reduce by prophylactic treatment with antihypertensive drugs. In clinical practice, however, only a minority of patients reach target blood pressure levels. The resulting gap between actual and potential health gains has been attributed to the fact that many patients do not take prescribed treatment as recommended, i.e. ”medication non-adherence”. This phenomenon is, however, insufficiently understood. We investigated the topic of adherence by way of a randomised questionnaire material comprising 1013 patients, and audio-recordings of 51 patient-physician consultations and 33 interviews with the patients made after the consultations. All patients came for regular follow-up appointments with their physicians and were under treatment with antihypertensives. In the questionnaire material, we found that patients who reported side effects of their drugs tended to rate their future risk of cardiovascular complications as being higher. Analysis of the interview data showed that patients had various reasons for sticking to the treatment recommendations: trust in physicians and wanting to avoid sequelae of hypertension were common arguments for doing so, while having side effects and disliking pharmaceuticals in general were reasons against. In the follow-up appointments, we found that the determinants of treatment decisions, i.e. the measured blood pressure values and (suspected) side effects, were defined through negotiation between patients and physicians. On the whole, patients and physicians were more in agreement about the interpretation of blood pressure values than of side effects, and physicians had the last say in the decision-making. We concluded that the antecedents of decisions about using medication are surrounded by uncertainty, and that it is the patient’s interpretation of the ”facts” that, ultimately, determines if and how antihypertensive medications will be taken.