Perception of hypertension management by patients and doctors in Asia: potential to improve blood pressure control

Abstract

Background: Hypertension is one of the world's most common health conditions and is a leading risk factor for mortality. Although blood pressure can be modified, there is a large proportion of patients whose blood pressure remains uncontrolled. The aim of this study, termed Edvantage 360°, was to gain a deeper understanding of hypertension management in Asia from the perspective of patients and doctors, and to propose strategies to improve blood pressure control.

Methods: Conducted in Hong Kong, Indonesia, Malaysia, the Philippines, South Korea, Taiwan, and Thailand, Edvantage 360° was a mixed-methods observational study that used both qualitative and quantitative elements: qualitative interviews and focus groups with patients (N = 110), quantitative interviews with patients (N = 709), and qualitative interviews with doctors (N = 85).

Results: This study found that, although there is good understanding of the causes and consequences of hypertension among Asian patients, there is a lack of urgency to control blood pressure. Doctors and patients have different expectations of each other and a divergent view on what constitutes successful hypertension management. We also identified a fundamental gap between the beliefs of doctors and patients as to who should be most responsible for the patients' hypertension management. In addition, because patients find it difficult to comply with lifestyle modifications (often because of a decreased understanding of the changes required), adherence to medication regimens may be less of a limiting factor than doctors believe.

Conclusions: Doctors may provide better care by aligning with their patients on a common understanding of successful hypertension management. Doctors may also find it helpful to provide a more personalized explanation of any needed lifestyle modifications. The willingness of the doctor to adjust their patient interaction style to form a 'doctor-patient team' is important. In addition, we recommend that doctors should not attribute ineffectiveness of the treatment plan to patient non-adherence to medications, but rather adjust the medication regimen as needed.

Keywords: Attitude to health; Hong Kong; Hypertension; Indonesia; Malaysia; Philippines; Qualitative research; South Korea; Taiwan; Thailand.

Figure 1

Patient perceptions of hypertension consequences. Patients believed that hypertension could lead to severe consequences. Top panel, white bars: patients who thought the condition was related to hypertension (N = 709). Top panel, black bars: of the patients who thought the condition was related to hypertension, patients who were very worried about the condition (stroke N = 577, heart attack or failure N = 563, coronary artery disease N = 357, nerve problems [loss of feeling, numbness] N = 366, kidney problems N = 269, circulation problems [e.g. ulcers] N = 234). Bottom panel, grey bars: patients from each country and/or region who thought stroke was related to hypertension. Of note, patients from Thailand were most concerned about nerve problems.

Figure 2

Patient beliefs regarding target blood pressure. Patients were generally only moderately concerned about reaching target blood pressure levels, although patient responses varied (N = 709).

Figure 3

Lifestyle changes to control hypertension. Many patients did not change their exercise regimen, diet, or stress management (N = 709).