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The perception that stress is the primary cause of hypertension, and that symptoms are a reliable indicator of blood pressure, is common among patients worldwide. The belief that medication needs to be taken only at times of stress or when the patient feels unwell is also widespread. Furthermore, many individuals intentionally stop taking their medication because of fears about addiction and adverse drug-related effects. These findings from a systematic review by researchers in the UK have been published in the BMJ.

Dr Iain Marshall and colleagues carried out a narrative synthesis of data from 53 qualitative studies (focus groups and interviews) into the perspectives of patients with uncomplicated hypertension. The investigators followed the model recommended by the UK Economic and Social Research Council guidelines. The selected studies involved patients in 16 countries. However, 20 reports were from the USA, and 24 included individuals only from ethnic-minority groups.

The most-commonly perceived cause of hypertension was stress, followed by diet, being overweight, family history, lack of exercise, and alcohol consumption. However, some more-unusual factors were also reported, such as witchcraft, exposure to chemicals, 'thick' blood, and having too much blood. Symptoms reported as being caused by hypertension resembled those commonly cited in the medical literature as being related to stress, such as headaches, dizziness, and palpitations. Many patients believed that taking their medications helped to relieve these symptoms, but that drugs were not needed when symptoms were absent. Discontinuation of drug therapy, both intentional and unintentional, was common. In six of the countries represented, patients reported using alternative therapies rather than their antihypertensive drugs. Sensitivity analysis demonstrated that patients' perceptions did not seem to be ethnically or culturally determined. The investigators conclude that “if they are to be successful at improving adherence, future educational interventions must incorporate and engage with these widespread perspectives and experiences”.