BMJ 2002;325:873 ( 19 October )

Primary care

Patients' decisions about whether or not to take antihypertensive drugs: qualitative study

John Benson, university lecturer in general practice, ^a Nicky Britten, director, GKT concordance unit. ^b

^a General Practice and Primary Care Research Unit, Institute of Public Health, Cambridge CB2 2SR, ^b Department of General Practice and Primary Care, Guy's, King's, and St Thomas's Hospital, London SE11 6SP

Correspondence to: J Benson jab62{at}medschl.cam.ac.uk

Objective: To describe the ways in which patients taking antihypertensive drugs balance reservations against reasons for taking them.
Design: Qualitative study using detailed interviews.
Setting: Two urban general practices in the United Kingdom.
Participants: Maximum variety sample of 38 interviewees receiving repeat perscriptions for antihypertensives.
Main outcome measures: Interviewees' reservations about drugs and reasons for taking antihypertensives.
Results: Patients had reservations about drugs generally and reservations about antihypertensives specifically. Reasons for taking antihypertensive drugs comprised positive experiences with doctors, perceived benefits of medication, and pragmatic considerations. Patients weighed their reservations against reasons for taking antihypertensives in a way that made sense for them personally. Some individual patients weighed different reservations against different reasons for taking antihypertensives.
Conclusions: Patients' ideas may derive from considerations unrelated to the drugs' pharmacology. Doctors who want their patients to make well informed choices about antihypertensives and to reach concordant decisions about prescribing should explore how individuals strike this balance, to personalise discussion of drug use.

What is already known on this topic Patients receiving treatment for chronic conditions often hold reservations about their drugs and make active decisions about continuing to use them What this study adds Many patients prescribed antihypertensive drugs hold reservations about medicines, but balance these against reasons to take them in ways that make sense to them individually Patients' ideas may derive from considerations unrelated to a drug's pharmacology Different patients may balance similar perceptions differently, and a single patient may balance multiple reservations against different reasons to take drugs Taking the patient's views into account when reviewing or initiating antihypertensive treatment may be helped by directly asking about patients' reservations, their reasons for taking medication, and the balance between them

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