Expectations of Blood Pressure Management in Hypertensive African-American Patients: A Qualitative Study

In patients with chronic diseases, expectations of care are associated with clinical outcomes. Using open-ended interviews, we elicited the expectations of treatment in 93 hypertensive African-American patients. During routine clinic visits, patients were asked, "What are your expectations of the treatment your doctor prescribed for your high blood pressure?" Their responses were explored with the probes: Do you expect to take your blood pressure medications for the rest of your life? Do you expect to take your medications daily regardless of symptoms? Do you expect a cure for your high blood pressure? Using standard qualitative techniques, patients' responses were grouped into a taxonomy of three categories of expectations reflecting patients' role, physicians' role, and medication effects. They expected to take active role in their treatment, especially as it relates to adoption of healthy behaviors. They expected their physicians to educate them about blood pressure treatment, and they expected medications to lower their blood pressure and prevent heart attack, stroke, and kidney failure. Despite such appropriate expectations, a considerable proportion of patients had nonbiomedical expectations of their treatment-38% expected a cure, 38% did not expect to take their medications for life and 23% take medications only with symptoms. The taxonomy of patient expectations outlined in this study may serve as a useful framework for patient education and counseling about hypertension and its management in this patient population.