Department of Primary Care and Medical Ethics, Amsterdam UMC, AMC, Amsterdam, Netherlands.
Department of Neurology, Amsterdam UMC, AMC, Amsterdam, Netherlands.
BMJ Open. 2019 Aug 18;9(8):e030742. doi: 10.1136/bmjopen-2019-030742.
Sixty-five per cent of older people have hypertension, but little is known about their preferences and concerns regarding hypertension management. Guidelines on hypertension lack consensus on how to treat older people without previous cardiovascular disease (CVD). This asks for explicit consideration of patient preferences in decision making. Therefore, the aim of this study was to explore older peoples' experiences, preferences, concerns and perceived involvement regarding hypertension management.
Qualitative interview study.
Participants were selected from 11 general practitioner (GP) practices in the Netherlands and purposively sampled until data saturation was achieved. Semistructured interviews were conducted, audio recorded and analysed by two researchers using thematic analysis.
Fifteen community dwelling older people aged 74-93 years with hypertension and without previous CVD participated.
Interviewees rarely started the conversation about hypertension management with their GP, although they did have concerns. Reasons for not discussing the subject included low priority of hypertension concerns, reliance on GPs or trust in GPs to make the right decision on their behalf. Also, interviewees anticipated regret of reducing medication, fearing vascular incidents. Interviewees would like to discuss tailoring treatment to their needs, deprescription of medication and ways to reduce side effects. They expected GPs to be more transparent on treatment effects.
Older people describe having little involvement in hypertension management, although they have several concerns. Since GPs are also known to be hesitant to bring up this subject, we signal a conspiracy of silence about antihypertensive medication. Through breaking this silence, GPs can facilitate shared decision-making on hypertension management and better tailored care.
65%的老年人患有高血压，但对于他们对高血压管理的偏好和关注却知之甚少。高血压指南在治疗无既往心血管疾病（CVD）的老年人方面缺乏共识。这就要求在决策中明确考虑患者的偏好。因此，本研究旨在探讨老年人在高血压管理方面的经验、偏好、关注点和感知参与度。
定性访谈研究。
参与者从荷兰的 11 家全科医生（GP）诊所中选择，并通过有目的抽样，直至达到数据饱和。进行半结构化访谈，由两名研究人员使用主题分析进行音频记录和分析。
15 名年龄在 74-93 岁、患有高血压且无既往 CVD 的社区居住老年人参与了研究。
受访者很少主动与他们的 GP 讨论高血压管理问题，尽管他们确实有一些担忧。不讨论该主题的原因包括对高血压担忧的优先级较低、依赖 GP 或信任 GP 代表他们做出正确的决定。此外，受访者期望减少药物治疗后会后悔，担心出现血管事件。受访者希望讨论根据他们的需求调整治疗方案、减少药物处方和减轻副作用的方法。他们希望 GP 更透明地说明治疗效果。
老年人表示他们在高血压管理中参与度较低，尽管他们有很多担忧。由于众所周知，GP 也不愿意提出这个话题，因此我们可以将这种对降压药物治疗的沉默描述为一种共谋。通过打破这种沉默，GP 可以促进高血压管理的共同决策和更好的个性化护理。
