title: The role of comorbidities in patients' hypertension self-management.
abstract: OBJECTIVE
  We sought to understand barriers to hypertension self-management in patients with hypertension and comorbidities.
  
  
  METHODS
  We conducted semi-structured, qualitative interviews with 48 patients with uncontrolled hypertension and at least one comorbidity to learn about beliefs and behaviors that might affect hypertension self-management. Using a grounded theory strategy, we analyzed interview transcripts detailing patients' hypertension self-management behaviors vis-à-vis a framework including Explanatory Models-a patient's understanding of the pathophysiology, cause, course, treatment, and severity of an illness, such as hypertension.
  
  
  RESULTS
  We identified four factors that interfered with hypertension self-management. (1) Interdependence: Participants saw hypertension as interconnected to their comorbidities and subsequently had difficulty separating information about their illnesses. (2) Low priority: Compared to other conditions, participants assigned hypertension a lower priority. (3) Conflicts: Participants struggled with conflicts between hypertension self-management practices and those for comorbidities. (4) Managing multiple medications: Polypharmacy led to patients' confusion and concern about taking medications as prescribed.
  
  
  CONCLUSIONS
  Participants did not experience hypertension as a discreet clinical condition; rather, they self-managed hypertension concurrently with other conditions, leading to a breakdown in hypertension self-management. We provide strategies to address each of the four barriers to better equip providers in addressing their clinically salient concerns.
authors.affiliation: 1Center for Healthcare Organization and Implementation Research (CHOIR), a VA HSR&D Center of Innovation, VA Boston Healthcare System and Edith Nourse Rogers Memorial VA Medical Center, MA, USA.
authors.forename: Gemmae M
authors.initials: GM
authors.lastname: Fix
authors.forename: Ellen S
authors.initials: ES
authors.lastname: Cohn
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Solomon
authors.forename: Dharma E
authors.initials: DE
authors.lastname: Cortés
authors.forename: Nora
authors.initials: N
authors.lastname: Mueller
authors.forename: Nancy R
authors.initials: NR
authors.lastname: Kressin
authors.forename: Ann
authors.initials: A
authors.lastname: Borzecki
authors.forename: Lois A
authors.initials: LA
authors.lastname: Katz
authors.forename: Barbara G
authors.initials: BG
authors.lastname: Bokhour
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D015897:Comorbidity; D019468:Disease Management; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009864:Ontario; D012648:Self Care / Q000379:methods*; D020377:Self Efficacy
keywords: Hypertension; comorbidity; patient adherence; qualitative; self-management
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