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Nasa dugo (‘It’s in the blood’): lay conceptions of hypertension in the Philippines
  1. Gideon Lasco1,2,
  2. Jhaki Mendoza3,
  3. Alicia Renedo4,
  4. Maureen L Seguin5,
  5. Benjamin Palafox5,
  6. Lia M Palileo-Villanueva3,
  7. Arianna Maever L Amit3,
  8. Antonio L Dans3,
  9. Dina Balabanova5,
  10. Martin McKee5
  1. 1Department of Anthropology, University of the Philippines Diliman, Quezon City, Metro Manila, Philippines
  2. 2Development Studies Program, Ateneo de Manila University, Quezon City, Philippines
  3. 3Department of Medicine, University of the Philippines Manila, Manila, Philippines
  4. 4Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
  5. 5London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Gideon Lasco; pdlasco{at}


Introduction Understanding explanatory models is important for hypertension, a leading risk factor for cardiovascular disease and stroke. This article aims to determine what adult patients with hypertension in the Philippines attribute their condition to, how these views might be explained and what the implications are for hypertension management.

Methods This is a qualitative study drawing on 71 semistructured interviews (40 initial and 31 follow-up) and four focus group discussions with patients diagnosed with hypertension. The setting was urban and rural low-income communities in the Philippines.

Results Four prominent perceived causes were identified—genetics, heat, stress and diet—for what patients refer to as ‘high blood’. We propose a ‘folk physiology’ that rests on local understandings of blood and blood flow, draws from broader cultural notions of illness causation and accounts for a dynamic, non-chronic view of hypertension that in turn informs the health behaviours of those affected.

Conclusions By understanding that hypertension is frequently seen not as a chronic constant condition but rather as an episodic one triggered by external influences, although in those genetically predisposed to it, it may be possible to address patient’s beliefs and thus adherence to treatment.

  • hypertension
  • qualitative study
  • health systems

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  • Handling editor Stephanie M Topp

  • Twitter @gideonlasco

  • Contributors GL conceptualised the paper and developed the initial draft, while JM, MM, AR and MLS played major roles in subsequent drafts. All authors contributed to the development, organisation and implementation of the study. They also edited and approved the final version.

  • Funding This study is supported by a grant from the Wellcome Trust/Newton Fund-MRC Humanities & Social Science Collaborative Award scheme (200346/Z/15/Z).

  • Competing interests ALD and LMP-V have been and/or are currently involved in clinical trials of antihypertensive medications that receive some funding from industry.

  • Patient consent for publication Not required.

  • Ethics approval Ethics approval was obtained from the London School of Hygiene and Tropical Medicine Observational Research Ethics Committee and the University of the Philippines Manila Research Ethics Board Panel 1 (Ref: 2017-481-01).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon request. The interview transcripts are available on request, and subject to gaining ethics approval, from the authors.