Study participants perceived stress, poor diet, being overweight, family history of hypertension, lack of exercise, alcohol use, hot environment, and other factors as causes of hypertension. Stress also was perceived as a consequence of hypertension.

Symptoms that patients associated with hypertension were headache, dizziness, palpitations, sweats, tiredness, neck pain, nausea, chest pain, visual changes, and nervousness; symptoms were thought to be linked with periods of elevated blood pressure.

Intentional nonadherence to drugs was common: Participants were less likely to take antihypertensive drugs when symptoms were absent. Participants stopped taking antihypertensive drugs because of side effects, perception that their blood pressure was controlled, fear of dependency, and preference for traditional or alternative treatments. Participants reported forgetfulness, lack of time, and lack of money as reasons for drug nonadherence.

Results were remarkably similar across ethnic groups and geographical regions.

Comment: Patients' understanding of causes and effects of hypertension — especially the presence or absence of symptoms — affects adherence to antihypertensive drug therapy. Other factors, such as forgetfulness and lack of money, also affect adherence.

Clinicians should explore their patients' perceptions about hypertension and its treatment and barriers to drug therapy, especially in patients whose blood pressure remains uncontrolled despite receiving prescriptions for antihypertensive drugs.

— Paul S. Mueller, MD, MPH, FACP Published inJournal Watch General MedicineAugust 7, 2012