Controlling Hypertension among African-Caribbean patients

The older age groups of African-Caribbean people are at particular risk of hypertension and stroke, and comprise the original migrant group who came to the UK in the 1955's and 1960's as young adults. This raises questions of the significance of traditional cultural beliefs and practices for health behaviours and medication use. AIMS: to examine 1) the cultural beliefs and medication practices of African-Caribbean and "white" hypertensive patients treated by general practices in Lambeth and 2) GPs awareness of the beliefs of African-Caribbean patients. METHODS: Case note review and semi-structured interviews with 60 hypertensive patients treated by general practices in Lambeth, and with 22 GPs from the study practices. RESULTS: Most African-Caribbean patients were aware of the risk of high blood pressure, although often adopting a fatalistic attitude. They had high levels of uncontrolled blood pressure and reported low levels of adherence with the prescribed medication (16/30 regularly "left off" the medication or took a reduced dose). Major reasons were concerns about possible present or future side-effects, fears of becoming "addicted" or "dependent" on the drugs, worries about mixing tablets with alcohol, and questioning their needs for the drugs. Familiarity with traditional herbal remedies increased worries about power of prescribed drugs and formed an alternative resource for managing illness. "Cerasee"(Momordica charantia) obtained from the local market was often taken for blood pressure problems and perceived as "natural" and less harmful than prescribed drugs. GPs were not aware of African-Caribbean patients' beliefs and medication practices, with implications both for prescribing and patients's interpretation of the information provided for their own self management. Feedback of the study findings was helpful to GPs in reducing cultural barriers to communication and managing this patient group. CONCLUSIONS: Low levels of compliance with treatment is likely to contribute to uncontrolled blood pressures among African-Caribbean population, while health promotion strategies require to take account of cultural beliefs and practices prevalent among the older generation of African-Caribbean people. Further work is planned (with Kings) to examine the use of herbal remedies among larger population samples, the phytochemical properties of Momordica charantia obtained from different outlets and its possible hypotensive effects. (AU)