To understand hypertensive patients' perspectives regarding blood pressure and hypertension treatment, this qualitative study applied semistructured interviews of hypertensive patients. Participants were recruited from two hypertension clinics at the University of Alberta in Edmonton, Canada. To be eligible for inclusion, patients had to be aged 18 years or older, diagnosed with hypertension by a healthcare provider, and currently taking an antihypertensive medication. Participants were stratified in the analysis according to blood pressure control. Twenty-six patients (mean age 57; 62% female) were interviewed, of which 42% were on target and 58% were not. Three underlying themes emerged from the interviews: (a) knowledge of blood pressure relating to diagnosis and management and control of hypertension, (b) integration of hypertension management into daily routine, and (c) feelings and beliefs of wellness. None of the above themes were associated with better control. Knowledge gaps were found, which emphasize the need for further patient education and physician training. Feelings and beliefs of wellness, and not knowledge, were important factors in home assessment of blood pressure. The absence of connections between control of hypertension and the identified domains indicates that current approaches could benefit from the development of a more personalized approach for education and communication. 1. Introduction Hypertension is highly prevalent, and although rates of detection and control of hypertension are improving in many countries, uncontrolled hypertension remains common [1] and medication and lifestyle adherence remains low. Nonadherence leads to substantial avoidable healthcare costs [2] because of inefficiencies in care delivery, discarded medications, and expenditures related to preventable hypertension-related sequelae [3]. Nonpharmacological interventions to improve hypertensive medication adherence are usually very complex involving both educational and behavioural interventions and data examining efficacy have not been consistent [4]. Improved understanding of the psychology of the hypertensive patient seems desirable. A number of patient-related barriers to optimizing blood pressure (BP) control have been identified. These include lack of patient knowledge, difficulty of treating an asymptomatic condition, personal beliefs that conflict with hypertension treatment goals, and other patient issues such as social economic status, cultural beliefs, access to care, psychosocial factors, and health literacy [5]. Additional obstacles include
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