Lived Experiences of Rural Elderly Managing Antihypertensive Side Effects: A Phenomenological Study
Main Article Content
Abstract
Hypertension management in elderly populations is a critical concern in global public health, particularly in rural areas where access to specialized care remains limited. While pharmacological control is often emphasized, little is known about how elderly individuals subjectively experience the side effects of antihypertensive medications. Despite advances in treatment adherence strategies, few studies have captured the emotional, cultural, and existential dimensions of chronic medication use among rural elderly populations. This study addresses the question: how do elderly patients in rural communities perceive, interpret, and respond to the side effects of antihypertensive therapy? Using a descriptive phenomenological approach, this study uncovers the lived experiences of rural elderly patients and interprets the meaning they assign to their bodily and emotional responses to medication. Data were collected through in-depth, semi-structured interviews with ten participants and analyzed thematically using Braun and Clarke’s framework supported by MAXQDA software. The findings reveal five key themes: bodily disruptions, emotional negotiation, cultural reinterpretation, adaptive coping, and silent endurance. These themes illustrate how medication side effects are interwoven with the patients’ sense of identity, daily functioning, and sociocultural context. Rather than passive recipients of care, participants emerged as active agents in managing their experiences through culturally informed and emotionally responsive strategies. These insights highlight the need for more empathetic and culturally sensitive healthcare practices in geriatric pharmacotherapy and suggest directions for future research that prioritize patient narratives as valid sources of clinical knowledge.
Article Details
Section
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Abdelkader, N. F., Abd El-Latif, A. M., & Khattab, M. M. (2020). Telmisartan/17β-estradiol mitigated cognitive deficit in an ovariectomized rat model of Alzheimer’s disease: Modulation of ACE1/ACE2 and AT1/AT2 ratio. Life Sciences, 245. Scopus. https://doi.org/10.1016/j.lfs.2020.117388
Alfian, S. D., van Boven, J. F. M., Abdulah, R., Sukandar, H., Denig, P., & Hak, E. (2021). Effectiveness of a targeted and tailored pharmacist-led intervention to improve adherence to antihypertensive drugs among patients with type 2 diabetes in Indonesia: A cluster randomised controlled trial. British Journal of Clinical Pharmacology, 87(4), 2032–2042. Scopus. https://doi.org/10.1111/bcp.14610
Alzahrani, A., Narala, S., Adel Ali Youssef, A., Nyavanandi, D., Bandari, S., Mandati, P., Almotairy, A., Almutairi, M., & Repka, M. (2022). Fabrication of a shell-core fixed-dose combination tablet using fused deposition modeling 3D printing. European Journal of Pharmaceutics and Biopharmaceutics, 177, 211–223. Scopus. https://doi.org/10.1016/j.ejpb.2022.07.003
Anaya, B. J., Cerda, J. R., D’Atri, R. M., Yuste, I., Luciano, F. C., Kara, A., Ruiz, H. K., Ballesteros, M. P., & Serrano, D. R. (2023). Engineering of 3D printed personalized polypills for the treatment of the metabolic syndrome. International Journal of Pharmaceutics, 642. Scopus. https://doi.org/10.1016/j.ijpharm.2023.123194
Bousquet, P., Hudson, A., García-Sevilla, J. A., & Li, J.-X. (2020). Imidazoline receptor system: The past, the present, and the future. Pharmacological Reviews, 72(1), 50–79. Scopus. https://doi.org/10.1124/pr.118.016311
bratty, M. A. (2020). Spectroscopic and molecular docking studies for characterizing binding mechanism and conformational changes of human serum albumin upon interaction with Telmisartan. Saudi Pharmaceutical Journal, 28(6), 729–736. Scopus. https://doi.org/10.1016/j.jsps.2020.04.015
Farkas, B., Balogh, A., Farkas, A., Marosi, G., & Nagy, Z. K. (2020). Frequency and waveform dependence of alternating current electrospinning and their uses for drug dissolution enhancement. International Journal of Pharmaceutics, 586. Scopus. https://doi.org/10.1016/j.ijpharm.2020.119593
Farmakis, I. T., Pyrgidis, N., Doundoulakis, I., Mykoniatis, I., Akrivos, E., & Giannakoulas, G. (2022). Effects of Major Antihypertensive Drug Classes on Erectile Function: A Network Meta-analysis. Cardiovascular Drugs and Therapy, 36(5), 903–914. Scopus. https://doi.org/10.1007/s10557-021-07197-9
Ghaem Far, Z., Babajafari, S., Kojuri, J., Mohammadi, S., Nouri, M., Rostamizadeh, P., Rahmani, M. H., Azadian, M., Ashrafi-Dehkordi, E., Zareifard, A., Golchin Vafa, R., & Mazloomi, S. M. (2021). Antihypertensive and antihyperlipemic of spirulina (Arthrospira platensis) sauce on patients with hypertension: A randomized triple-blind placebo-controlled clinical trial. Phytotherapy Research, 35(11), 6181–6190. Scopus. https://doi.org/10.1002/ptr.7254
Giri, B. R., Kwon, J., Vo, A. Q., Bhagurkar, A. M., Bandari, S., & Kim, D. W. (2021). Hot-melt extruded amorphous solid dispersion for solubility, stability, and bioavailability enhancement of telmisartan. Pharmaceuticals, 14(1), 1–18. Scopus. https://doi.org/10.3390/ph14010073
Haggag, Y. A., Yasser, M., Tambuwala, M. M., El Tokhy, S. S., Isreb, M., & Donia, A. A. (2021). Repurposing of Guanabenz acetate by encapsulation into long-circulating nanopolymersomes for treatment of triple-negative breast cancer. International Journal of Pharmaceutics, 600. Scopus. https://doi.org/10.1016/j.ijpharm.2021.120532
Khanfar, M., Al-Remawi, M., Al-Akayleh, F., & Hmouze, S. (2021). Preparation and Evaluation of Co-amorphous Formulations of Telmisartan—Amino Acids as a Potential Method for Solubility and Dissolution Enhancement. AAPS PharmSciTech, 22(3). Scopus. https://doi.org/10.1208/s12249-021-01952-9
Martelli, A., Piragine, E., Citi, V., Testai, L., Pagnotta, E., Ugolini, L., Lazzeri, L., Di Cesare Mannelli, L., Manzo, O. L., Bucci, M., Ghelardini, C., Breschi, M. C., & Calderone, V. (2020). Erucin exhibits vasorelaxing effects and antihypertensive activity by H2S-releasing properties. British Journal of Pharmacology, 177(4), 824–835. Scopus. https://doi.org/10.1111/bph.14645
Nasr, A. M., Moftah, F., Abourehab, M. A. S., & Gad, S. (2022). Design, Formulation, and Characterization of Valsartan Nanoethosomes for Improving Their Bioavailability. Pharmaceutics, 14(11). Scopus. https://doi.org/10.3390/pharmaceutics14112268
Pan, J., Hu, B., Wu, L., & Li, Y. (2021). The effect of social support on treatment adherence in hypertension in China. Patient Preference and Adherence, 15, 1953–1961. Scopus. https://doi.org/10.2147/PPA.S325793
Peeters, L. E. J., Feyz, L., Hameli, E., Zwart, T., Bahmany, S., Daemen, J., Van Gelder, T., Versmissen, J., & Koch, B. C. P. (2020). Clinical Validation of a Dried Blood Spot Assay for 8 Antihypertensive Drugs and 4 Active Metabolites. Therapeutic Drug Monitoring, 42(3), 460–467. Scopus. https://doi.org/10.1097/FTD.0000000000000703
Pop, G., Farcaș, A., Butucă, A., Morgovan, C., Arseniu, A. M., Pumnea, M., Teodoru, M., & Gligor, F. G. (2022). Post-Marketing Surveillance of Statins—A Descriptive Analysis of Psychiatric Adverse Reactions in EudraVigilance. Pharmaceuticals, 15(12). Scopus. https://doi.org/10.3390/ph15121536
Shen, Z., Shi, S., Ding, S., & Zhong, Z. (2020). Mediating Effect of Self-Efficacy on the Relationship Between Medication Literacy and Medication Adherence Among Patients With Hypertension. Frontiers in Pharmacology, 11. Scopus. https://doi.org/10.3389/fphar.2020.569092
Tachapuripunya, V., Roytrakul, S., Chumnanpuen, P., & E-kobon, T. (2021). Unveiling putative functions of mucus proteins and their tryptic peptides in seven gastropod species using comparative proteomics and machine learning-based bioinformatics predictions. Molecules, 26(11). Scopus. https://doi.org/10.3390/molecules26113475
Trifirò, G., Massari, M., Da Cas, R., Menniti Ippolito, F., Sultana, J., Crisafulli, S., Giorgi Rossi, P., Marino, M., Zorzi, M., Bovo, E., Leoni, O., Ludergnani, M., Spila Alegiani, S., Spila Alegiani, S., Traversa, G., Onder, G., Ientile, V., Grilli, R., Formoso, G., … Gion, M. (2020). Renin–Angiotensin–Aldosterone System Inhibitors and Risk of Death in Patients Hospitalised with COVID-19: A Retrospective Italian Cohort Study of 43,000 Patients. Drug Safety, 43(12), 1297–1308. Scopus. https://doi.org/10.1007/s40264-020-00994-5