Qualitative insights into the experiences and goals of people living with severe difficult-to-treat hypertension in Australia

BACKGROUND: Over one-third of Australian adults have hypertension, and this rate increases with age. Difficult-to-treat hypertension is high blood pressure that remains above target levels despite proper medicine adherence. This study explored the treatment experiences and goals of patients with severe difficult-to-treat hypertension to gain insights into renal denervation (RDN) as a therapeutic option. METHODS: Twelve Australian participants with severe difficult-to-treat hypertension were interviewed. Participants were recruited via a specialist recruitment company and specialist referral. Semi-structured interviews lasted about 60 min either online or by phone. Interviews were recorded and transcribed verbatim. Transcripts were analyzed using inductive and deductive thematic analysis in NVivo. RESULTS: Participants had an average age of 65 years (range: 48-75 years), 58% identified as male and all lived across Australia, primarily in metropolitan areas (n = 9; 75%). The average time since hypertension diagnosis was 22 years (range: 3-44 years) and nearly all participants had a family history of hypertension. Data analysis identified four themes regarding participants' experiences of living with severe difficult-to-treat hypertension and awareness of renal denervation therapy: (1) Diagnosis and monitoring of hypertension, (2) The impact of severe difficult-to-treat hypertension on quality of life, (3) The management of severe difficult-to-treat hypertension and (4) Awareness, perceptions and experiences with RDN. CONCLUSIONS: This study provides an in-depth understanding of the experiences of people living with severe difficult-to-treat hypertension and their treatment goals. It highlights the significant impact and stigma of living with severe difficult-to-treat hypertension, and the need to incorporate psychosocial support and patient education into the clinical management of this chronic condition.