Objectives: Blood pressure control is important for reducing the risk of diseases related to arteriosclerosis. However, medication non-adherence by patients is a constant challenge for health care practitioners. To understand the complexity of medication non-adherence, qualitative evaluation of patient perspectives on prescribed medications is being undertaken worldwide, but such studies are scarce in Japan. This study attempted to investigate qualitatively the perspectives of patients with high blood pressure on antihypertensive drugs.
Methods: Medical consultations were observed and qualitative interviews with patients were conducted in the following two clinical settings: medical consultations for cardiovascular diseases (n=82; 47 males, 35 females; age, 68 ± 11 years) and consultations for Kampo medicine (n=31; 18 males, 13 females; age, 72 ± 8 years). The narratives were categorized, and the reasons for medication non-adherence were determined using a cultural anthropological method.
Results: The narratives were categorized into the following 5 types: (1) willingness to take drugs because of concern about hypertension, (2) taking drugs as prescribed, but without interest in blood pressure changes, (3) no hesitation in taking antihypertensive drugs despite adverse side effects experienced after taking these drugs, (4) taking antihypertensive drugs and objectively describing how blood pressure changed on a daily basis, and (5) taking antihypertensive drugs while having concern about future side effects, or not wanting to take antihypertensive drugs. Furthermore, the concern over medications and medication non-adherence shown in (5) were attributed to a combination of the following 4 reasons: (1) prior experience in medical care, (2) physical sensations, (3) political and economic reasons, (4) a negative opinion toward modern medicine, and (5) the description of side effects listed on package inserts.
Conclusion: Most patients take antihypertensive drugs because they consider the drugs to be essential for their health. However, some patients are concerned about or reject the medications. If such concern or rejection is not based on medical reason, understanding the patients' views from their sociocultural, political, and economic perspectives is important to improve adherence.

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Objective: To determine the feasibility of low-dose, intermittent administration of trimethoprim-sulfamethoxazole (TMP/SMX) for prophylaxis against pneumocystis pneumonia (PCP) in patients with systemic autoimmune diseases receiving medium- to high-dose glucocorticoid therapy.
Methods: A randomized prospective study was performed. Patients who were scheduled to receive medium- to high-dose glucocorticoid therapy were selected and randomly allocated to one of two groups: one group received 1 tablet of TMP/SMX (TMP 80 mg and SMX 400 mg) daily and the other group received 1 tablet twice a week. The observation period was up to one year, or until the prophylactic therapy was discontinued because of steroid tapering or occurrence of adverse events (AEs). The endpoint was occurrence of PCP, and safety was also assessed.
Results: Thirty-seven patients were enrolled in this study, with 19 patients assigned to the daily regimen and 18 to the twice weekly regimen. One patient in each group withdrew before starting treatment. None of the patients who entered this study developed PCP. Safety analysis showed fewer AEs with the twice weekly regimen than with the daily regimen (5 of 17 patients (29.4%) vs. 10 of 18 patients (55.6%), p＝0.176).
Conclusion: From this pilot study, twice weekly TMP/SMX prophylaxis seems to be more tolerable than daily dosing in patients with systemic autoimmune diseases receiving medium- to high-dose glucocorticoid therapy. Since the number of patients was insufficient, further study is necessary to determine the optimal regimen for PCP prevention in these patients.

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