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Hypertension management: experiences, wishes and concerns among older people—a qualitative study

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...

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Autores principales: van Bussel, Emma, Reurich, Leony, Pols, Jeannette, Richard, Edo, Moll van Charante, Eric, Ligthart, Suzanne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6701601/
https://www.ncbi.nlm.nih.gov/pubmed/31427342
http://dx.doi.org/10.1136/bmjopen-2019-030742
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author van Bussel, Emma
Reurich, Leony
Pols, Jeannette
Richard, Edo
Moll van Charante, Eric
Ligthart, Suzanne
author_facet van Bussel, Emma
Reurich, Leony
Pols, Jeannette
Richard, Edo
Moll van Charante, Eric
Ligthart, Suzanne
author_sort van Bussel, Emma
collection PubMed
description 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.
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spelling pubmed-67016012019-09-02 Hypertension management: experiences, wishes and concerns among older people—a qualitative study van Bussel, Emma Reurich, Leony Pols, Jeannette Richard, Edo Moll van Charante, Eric Ligthart, Suzanne BMJ Open Qualitative Research 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. BMJ Publishing Group 2019-08-18 /pmc/articles/PMC6701601/ /pubmed/31427342 http://dx.doi.org/10.1136/bmjopen-2019-030742 Text en © 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/.
spellingShingle Qualitative Research
van Bussel, Emma
Reurich, Leony
Pols, Jeannette
Richard, Edo
Moll van Charante, Eric
Ligthart, Suzanne
Hypertension management: experiences, wishes and concerns among older people—a qualitative study
title Hypertension management: experiences, wishes and concerns among older people—a qualitative study
title_full Hypertension management: experiences, wishes and concerns among older people—a qualitative study
title_fullStr Hypertension management: experiences, wishes and concerns among older people—a qualitative study
title_full_unstemmed Hypertension management: experiences, wishes and concerns among older people—a qualitative study
title_short Hypertension management: experiences, wishes and concerns among older people—a qualitative study
title_sort hypertension management: experiences, wishes and concerns among older people—a qualitative study
topic Qualitative Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6701601/
https://www.ncbi.nlm.nih.gov/pubmed/31427342
http://dx.doi.org/10.1136/bmjopen-2019-030742
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