title: Metaphorical constructions of hypertension among three ethnic groups in the Netherlands.
abstract: BACKGROUND
  This article examines the various metaphors used by hypertensive patients from different ethnic groups in multi-ethnic and multicultural Netherlands. The choice for the study of metaphors is based on the need of people to use metaphors, analogies and symbols to make sense of and express their illness experiences. Given the high prevalence of hypertension in Western countries, such as the Netherlands, and the fact that hypertension is also a major risk factor for cardiovascular disease among immigrants makes it necessary to study the various metaphors these groups use when speaking about the causes and consequences of their hypertension. This can contribute to a shared understanding and communication about this illness.
  
  
  METHODS
  Discursive analysis of the metaphorical constructions of the causes and consequences of hypertension 55 participants of Creole, (White) Dutch and Hindustani descent employed in-depth interviews.
  
  
  RESULTS
  The findings illustrate that the participants use several metaphors to 'live' their hypertension. The metaphors some of the participants employed to explain the origins of their hypertension construct the human body and its organs as machines or parts of machines. When speaking about the possible consequences the participants used metaphors that represented of hypertension as an unknown enemy, they feared because of its silent, invisible and uncontrollable character and the way it abruptly makes itself known.
  
  
  CONCLUSIONS
  Metaphors people employ to speak about their hypertension open up a space for patients to explain how they understand their hypertension and how they want to live with it even if it means resisting recommendations put forward by their doctors. It is therefore necessary to find metaphors that can work for health care providers and patients that work the best for communication about hypertension and its medical treatment.
authors.affiliation: Department of Sociology, Faculty of Social Sciences, VU University Amsterdam, Amsterdam, The Netherlands. j.schuster@vu.nl
authors.forename: John
authors.initials: J
authors.lastname: Schuster
authors.forename: Erik
authors.initials: E
authors.lastname: Beune
authors.forename: Karien
authors.initials: K
authors.lastname: Stronks
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D018864:Cultural Diversity; D003469:Culture; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology / Q000208:ethnology* / Q000523:psychology; D007194:India / Q000208:ethnology; D007406:Interview, Psychological; D008297:Male; D019365:Metaphor; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors