Skip to content

Hypertension patient-voice — annotated sources

Last updated: 2026-09-01

Every PubMed identifier below was resolved by live E-utilities query on 2026-09-01; every URL was retrieved on the same date. Annotations state what each source contributes and what it does not. Method and ethics: README.md.

Qualitative evidence syntheses

  • Natale P, et al. Perspectives and Experiences of Self-monitoring of Blood Pressure Among Patients With Hypertension: A Systematic Review of Qualitative Studies. Am J Hypertens. 2023;36:372-384. PMID 36840919. Thematic synthesis of 35 studies and 872 patients aged 18–95, searched to March 2022. The single most useful source in this layer: it establishes that self-monitoring is not experienced as unambiguously empowering, and names the specific failure modes — not knowing the target, not knowing how to respond to a reading, anxiety over unfavourable numbers, and cost of the device. Limitation: thematic synthesis inherits the sampling of its constituent studies, which are predominantly from high-income settings.
  • Li Q, et al. Physical activity experience of patients with hypertension: a systematic review and synthesis of qualitative literature. BMC Public Health. 2024;24:2826. PMID 39407187. 17 studies, 85 findings, synthesised onto the Capability–Opportunity–Motivation–Behaviour model. Useful because it separates the environmental from the motivational determinants rather than collapsing both into "adherence". Limitation: framework synthesis imposes a model that may under-represent findings that do not fit it.

Primary qualitative studies — high-income settings

  • Malkon S, et al. A Qualitative Study on Patients' Views on Hypertension and Antihypertensive Medications. Patient Prefer Adherence. 2023;17:3331-3339. PMID 38106370. 219 treated patients aged ≥30 across 25 Stockholm primary care centres, analysed against WHO's five adherence dimensions. Contributes the twin findings of limited disease understanding and fear of adverse effects, plus health-system observations about appointment length and prescribing without conversation. Limitation: free-text responses to a survey rather than interviews, so depth is limited.
  • van Bussel E, et al. Hypertension management: experiences, wishes and concerns among older people—a qualitative study. BMJ Open. 2019;9:e030742. PMID 31427342. 15 community-dwelling Dutch people aged 74–93 with hypertension and no prior cardiovascular disease, purposively sampled to saturation from 11 general practices. The source for the mutual-silence finding about deprescribing. Limitation: small, single-country, and deliberately restricted to people without prior cardiovascular disease — the group in whom the treatment decision is most finely balanced.
  • Ghai I, et al. Barriers and facilitators of habit building for long-term adherence to antihypertensive therapy among people with hypertensive disorders in Los Angeles, California: a qualitative study. BMJ Open. 2024;14:e079401. PMID 38991671. 20 patients and 7 providers, semi-structured interviews, 2021–2022. Contributes the finding that side effects can act as either barrier or facilitator of habit formation, and that regimen changes and polypharmacy disrupt habit. Also elicited feedback on intervention design. Limitation: single centre; the sample was recruited for an intervention-development study, so participants may be unusually engaged.
  • Tsiantou V, et al. Factors affecting adherence to antihypertensive medication in Greece: results from a qualitative study. Patient Prefer Adherence. 2010;4:335-43. PMID 20859460. Older but independently corroborates the fear-of-adverse-effects theme in a different health system.
  • Bane C, et al. The journey to concordance for patients with hypertension: a qualitative study in primary care. Pharm World Sci. 2007;29:534-40. PMID 17487567. Frames adherence as a longitudinal process rather than a binary state. Retained as an observation rather than a theme pending contemporary replication.
  • Mondesir FL, et al. Patient Perspectives on Factors Influencing Medication Adherence Among People with Coronary Heart Disease (CHD) and CHD Risk Factors. Patient Prefer Adherence. 2019;13:2017-2027. PMID 31819383. Adjacent rather than hypertension-specific; included for the risk-factor population.

Primary qualitative studies — low- and middle-income settings

  • Edward A, et al. Patient and healthcare provider perspectives on adherence with antihypertensive medications: an exploratory qualitative study in Tanzania. BMC Health Serv Res. 2021;21:834. PMID 34407820. Includes both patient and provider perspectives, which most studies do not.
  • Gupta S, et al. Qualitative Study of Barriers to Adherence to Antihypertensive Medication among Rural Women in India. Int J Hypertens. 2019;2019:5749648. PMID 30809390. Specifically rural and specifically women — a combination rarely sampled.
  • Basu S, et al. Determinants of adherence to antihypertensive treatment among patients attending a primary care clinic with limited medical armamentarium in Delhi, India: A qualitative study. Chronic Illn. 2022;18:295-305. PMID 32938210. Notable for being set in a clinic with explicitly limited drug availability, which separates supply constraints from patient choice.
  • Najjuma JN, et al. Adherence to Antihypertensive Medication: An Interview Analysis of Southwest Ugandan Patients' Perspectives. Ann Glob Health. 2020;86:58. PMID 32897274.
  • Oyibo P, et al. Barriers and Enablers of Antihypertensive Adherence Among a Nigerian Adult Hypertensive Population Seeking Care in Public Secondary Health Facilities in Delta State, Nigeria: A Mixed Methods Study. West Afr J Med. 2025;42:240-247. PMID 40845429.
  • Rahmawati R, et al. Understanding untreated hypertension from patients' point of view: A qualitative study in rural Yogyakarta province, Indonesia. Chronic Illn. 2018;14:228-240. PMID 28669227. Rare and valuable: samples people who are not in treatment, which almost no other study in this collection does.
  • Shamsi A, et al. Life experiences of patients before having hypertension: a qualitative study. Electron Physician. 2017;9:3925-3933. PMID 28461866. Retrospective accounts of the pre-diagnosis period.
  • M Yatim H, et al. Factors influencing patients' hypertension self-management and sustainable self-care practices: a qualitative study. Public Health. 2019;173:5-8. PMID 31207425.
  • Abdul Wahab NA, et al. Exploring Culture, Religiosity and Spirituality Influence on Antihypertensive Medication Adherence Among Specialised Population: A Qualitative Ethnographic Approach. Patient Prefer Adherence. 2021;15:2249-2265. PMID 34675490. Ethnographic rather than interview-based, which gives it a different kind of access.
  • Singh K, et al. Patient experiences and perceptions of chronic disease care during the COVID-19 pandemic in India: a qualitative study. BMJ Open. 2021;11:e048926. PMID 34145019. Documents care disruption from the patient's side.
  • Sandeep M, et al. Prevalence of Non-Adherence to Antihypertensive Medication in India: A Systematic Review and Meta-Analysis of 18,808 Hypertensive Patients. Curr Hypertens Rev. 2025;21:231-246. PMID 40926604. Quantitative rather than qualitative; included to give the Indian qualitative studies a denominator.

Studies of specific populations

  • Abel WM, et al. Antihypertensive medication adherence and persistence among Black women: A qualitative study. Nurse Pract. 2022;47:40-47. PMID 35171867.
  • Yogarajah N, et al. Exploring adherence to antihypertensive medication in Black African and Black Caribbean residents in South East London: a qualitative study. BJGP Open. 2025;9. PMID 40389279.
  • Al-Bayan M, et al. Neighborhood perceptions and hypertension among low-income black women: a qualitative study. BMC Public Health. 2016;16:1075. PMID 27733142. The clearest link in this collection between structural conditions and patients' own causal explanations.
  • Ayodele V, et al. Managing Blood Pressure Beyond Viral Suppression: Patient and Provider Perspectives on Antihypertensive Medication Adherence in HIV Care: A Qualitative Study. Res Sq. 2026. PMID 42239779. Preprint — flagged as such; not peer-reviewed at retrieval, and used only for a below-threshold observation.

Trial-embedded qualitative and process evaluation

  • Kohrman N, et al. A qualitative analysis of post-hoc interviews with multilevel participants of a randomized controlled trial. PLoS One. 2024;19:e0303075. PMID 38723012. Interviews with participants, barbers and pharmacists after the barbershop blood-pressure trial. The best available account of why moving care into a trusted existing setting worked.
  • Grant S, et al. Using mHealth for the management of hypertension in UK primary care: an embedded qualitative study of the TASMINH4 randomised controlled trial. Br J Gen Pract. 2019;69:e612-e620. PMID 31262847.
  • Cairns AE, et al. Implementing self-management: a mixed methods study of women's experiences of a postpartum hypertension intervention (SNAP-HT). Trials. 2020;21:508. PMID 32517785.
  • Kovoor JG, et al. Participants' views of ultra-low dose combination therapy for high blood pressure: a mixed-methods study from the QUARTET trial. J Hum Hypertens. 2024;38:516-522. PMID 38744907. Rare: patients' own assessment of a specific pharmacological strategy rather than of adherence in general.
  • Baratta J, et al. Patient and Health Professional Perceptions of Telemonitoring for Hypertension Management: Qualitative Study. JMIR Form Res. 2022;6:e32874. PMID 35687380.
  • Strandberg S, et al. Self-care management and experiences of using telemonitoring as support when living with hypertension or heart failure: A descriptive qualitative study. Int J Nurs Stud Adv. 2023;5:100149. PMID 38746569.

Quantitative sources on the patient-side burden

  • Di M, et al. Lack of effects of evidence-based, individualised counselling on medication use in insured patients with mild hypertension in China: a randomised controlled trial. BMJ Evid Based Med. 2020;25:102-108. PMID 31473598. Individualised counselling included 10-year cardiovascular risk, absolute risk reduction, adverse effects and cost. Neither medication use nor adherence differed significantly at 6 months; this directly corrects the former assertion that absolute-benefit communication had never been trialled.
  • Singhal K, et al. A parallel-arm randomised control trial to study the effects of risk communication methods for prevention of cardiovascular diseases: EFFRICO trial. J Family Med Prim Care. 2024;13:1922-1930. PMID 38948564. Compared 10-year Framingham risk, heart age and routine care in 159 adults with hypertension and/or diabetes; the risk-score outcome did not differ significantly. The intervention was broader than absolute-versus-relative framing.
  • Reddy RV, et al. Cost-related medication nonadherence in adults with hypertension in the USA: implications for healthcare quality. Int J Qual Health Care. 2025;37. PMID 40285540.
  • Piette JD, et al. Medication characteristics beyond cost alone influence decisions to underuse pharmacotherapy in response to financial pressures. J Clin Epidemiol. 2006;59:739-46. PMID 16765278.
  • Johnston ME, et al. Effects of labelling on income, work and social function among hypertensive employees. J Chronic Dis. 1984;37:417-23. PMID 6725496. The historical source for labelling harm. Old, and its labour-market context has changed, but no contemporary replacement was found in this search.
  • Tucker KL, et al. Self-monitoring of blood pressure in hypertension: A systematic review and individual patient data meta-analysis. PLoS Med. 2017;14:e1002389. PMID 28926573. Quantitative counterpart to T3: self-monitoring without a co-intervention produces no benefit, which matches patients' description of it as burden without direction.
  • Sheppard JP, et al. Effect of Antihypertensive Medication Reduction vs Usual Care on Short-term Blood Pressure Control in Patients With Hypertension Aged 80 Years and Older: The OPTIMISE Randomized Clinical Trial. JAMA. 2020;323:2039-2051. PMID 32453368. Quantitative counterpart to T7.

Organisation and campaign sources

All retrieved 2026-09-01; full directory with roles in organizations.md.

  • World Hypertension League, https://www.whleague.org/
  • International Society of Hypertension, https://ish-world.com/
  • May Measurement Month, https://www.maymeasure.org/
  • World Heart Federation, https://world-heart-federation.org/
  • Resolve to Save Lives, https://resolvetosavelives.org/
  • World Health Organization — HEARTS technical package, https://www.who.int/teams/noncommunicable-diseases/hearts-technical-package
  • Pan American Health Organization — HEARTS in the Americas, https://www.paho.org/en/hearts-americas
  • STRIDE BP, https://www.stridebp.org/
  • European Society of Hypertension, https://www.eshonline.org/
  • Pan-African Society of Cardiology, https://www.pascar.org/
  • Blood Pressure UK, https://www.bloodpressureuk.org/
  • British Heart Foundation — high blood pressure, https://www.bhf.org.uk/informationsupport/risk-factors/high-blood-pressure
  • NHS — high blood pressure, https://www.nhs.uk/conditions/high-blood-pressure/
  • Hypertension Canada, https://hypertension.ca/
  • Heart and Stroke Foundation of Canada — high blood pressure, https://www.heartandstroke.ca/heart-disease/risk-and-prevention/condition-risk-factors/high-blood-pressure
  • Heart Foundation (Australia), https://www.heartfoundation.org.au/
  • Hypertension Australia, https://www.hypertension.org.au/
  • National Heart, Lung, and Blood Institute — high blood pressure, https://www.nhlbi.nih.gov/health/high-blood-pressure

Coverage limits — read this before using the layer

  1. Almost all of this literature asks one question. The dominant research question is "why don't people take their tablets?" Studies asking what patients want from hypertension care, what the diagnosis means to them over a life, or how they weigh a decades-distant statistical benefit are much rarer. The themes in themes.md therefore over-represent adherence and under-represent everything else.
  2. People not in treatment are nearly absent. Only one study in this collection deliberately sampled people with untreated hypertension (PMID 28669227). Everyone else was recruited from clinics, trials or registries — the very people whose behaviour is least in question.
  3. No source captures people who stopped. Discontinuation is inferred from adherence data, never described by the people who did it.
  4. Chemical adherence testing, which produces the most reliable adherence estimates, has been used overwhelmingly in tertiary care and in predominantly White populations, and key sociodemographic variables often go unreported (PMID 40371625). This limits what can be said about who is non-adherent and why.
  5. No English-language search was supplemented by non-English databases, so qualitative literature published only in Chinese, Japanese, Spanish, Portuguese, Arabic or Russian is missing, despite those settings carrying much of the global burden.
  6. One source is a preprint (PMID 42239779) and is flagged in place; it supports only a below-threshold observation.
  7. Three organisations could not be described from their own sites because retrieval returned access-control responses (American Heart Association, US Centers for Disease Control and Prevention) or a non-English error page (Japanese Society of Hypertension). They are recorded with that limitation stated rather than described from memory.
  8. No patient-organisation story pages, news features or videos are used. The organisation search repeated on 2026-09-01 found Blood Pressure UK as the clearest dedicated patient-facing exception; the remainder were predominantly professional societies, general cardiovascular charities and public-health agencies. The absence here is therefore stated as a dated source-coverage result, not as a universal claim that such advocacy does not exist.