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Qualitative research
Research
Hypertension management: experiences, wishes and concerns among older people—a qualitative study
  1. Emma van Bussel1,
  2. Leony Reurich1,
  3. Jeannette Pols1,
  4. Edo Richard2,3,
  5. Eric Moll van Charante1,
  6. Suzanne Ligthart4
  1. 1 Department of Primary Care and Medical Ethics, Amsterdam UMC, AMC, Amsterdam, Netherlands
  2. 2 Department of Neurology, Amsterdam UMC, AMC, Amsterdam, Netherlands
  3. 3 Department of Neurology, Radbout University Medical Center, Nijmegen, Netherlands
  4. 4 Department of Primary and Community Care, Radbout University Medical Center, Nijmegen, Netherlands
  1. Correspondence to Dr Eric Moll van Charante; e.p.mollvancharante{at}amc.uva.nl

Abstract

Objectives Sixty-five per cent of older people have hypertension, but little is known about their preferences and concerns regarding hypertension management. Guidelines on hypertension lack consensus on how to treat older people without previous cardiovascular disease (CVD). This asks for explicit consideration of patient preferences in decision making. Therefore, the aim of this study was to explore older peoples’ experiences, preferences, concerns and perceived involvement regarding hypertension management.

Design Qualitative interview study.

Setting Participants were selected from 11 general practitioner (GP) practices in the Netherlands and purposively sampled until data saturation was achieved. Semistructured interviews were conducted, audio recorded and analysed by two researchers using thematic analysis.

Participants Fifteen community dwelling older people aged 74–93 years with hypertension and without previous CVD participated.

Results Interviewees rarely started the conversation about hypertension management with their GP, although they did have concerns. Reasons for not discussing the subject included low priority of hypertension concerns, reliance on GPs or trust in GPs to make the right decision on their behalf. Also, interviewees anticipated regret of reducing medication, fearing vascular incidents. Interviewees would like to discuss tailoring treatment to their needs, deprescription of medication and ways to reduce side effects. They expected GPs to be more transparent on treatment effects.

Conclusion Older people describe having little involvement in hypertension management, although they have several concerns. Since GPs are also known to be hesitant to bring up this subject, we signal a conspiracy of silence about antihypertensive medication. Through breaking this silence, GPs can facilitate shared decision-making on hypertension management and better tailored care.

  • hypertension management
  • older people
  • primary care
  • shared decision-making conspiracy of silence

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

http://dx.doi.org/10.1136/bmjopen-2019-030742

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    Footnotes

    • Author contributions EvB, LR, JP, ER, EMvC and SL contributed to the conception or design of the work. EvB and LR performed the interviews. EvB, LR, JP, ER, EMvC and SL contributed to the acquisition, analysis or interpretation of data for the work. EvB drafted the manuscript. EvB, LR, JP, ER, EMvC and SL critically revised the manuscript and gave final approval and agree to be accountable for all aspects of work ensuring integrity and accuracy.

    • Funding This research was supported by the Netherlands Organisation for Health Research and Development (grant number 839110003).

    • Disclaimer The funders had no role in study design, methods, subject recruitment, data collection and analysis, interpretation of data, preparation of the manuscript or the decision to publish. No financial disclosures were reported by the authors of this manuscript.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethical approval Official approval of this study was waived by the Medical Ethics Review Committee of the Academic Medical Centre in Amsterdam (reference W18_004#18.015), the Netherlands.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data underlying our findings cannot be made publicly available for ethical reasons; public availability would compromise our participants' privacy. Data requests may be sent to the corresponding author at e.p.mollvancharante@amc.uva.nl.

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    © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.