Accepting the unacceptable

OBJECTIVE: To gain deep insight into what it means for patients to live with drug-treated hypertension and to understand the implications for the doctors' influence on patients' adherence.

METHODS: Group discussions with 43 drug-treated hypertensive patients. Documentary method was used for interpretative analysis.

RESULTS: Four basic phenomena were identified (fear, ignorance, reluctance to discuss matters with the doctor, impact of illness experiences), which resulted in different types of action patterns: (1) the assertive actor, (2) the unconscious avoider, and (3) the inconsistent actor. The types of action patterns do not refer to any implications for adherence. The patients' action does not indicate their preferred model of doctor-patient interaction or their acceptance of taking medication.

CONCLUSION: Adherence must not be seen as meaningless behaviour, which can simply be learned, but rather as the result of subjective experiences on living with hypertension and the ability to accept the diagnosis and its treatment.

PRACTICE IMPLICATIONS: It is premature to initiate therapy straight after the diagnosis, before the patient is prepared to take the tablets. Supporting adherence means to stay in dialogue and to give the time, privacy and patience to enable patients to overcome their inhibitions of asking and to accept the therapy.