Background: The prevalence of stage 2 hypertension approaches one-third in adult Nepalis and despite inexpensive effective treatment, long-term compliance is poor. World-wide, a major impediment is the incongruity between hypertension and patients’ symptom-based illness representations. The Common-Sense Model of Self-regulation was used to investigate Nepali illness representations through open-ended interviews of patients with hypertension.Methods: In a tertiary hospital setting, 50 self-identified hypertensive patients were interviewed about their representations of health, hypertension, and hypertensive treatment. Responses were analyzed with a modified Interpretative Phenomenological Analysis.Results: An Ayurvedic-influenced health model appeared in illness identity and coping responses. Hypertension was identified as a serious disease having observable, wide-ranging symptoms with chronic and intermittent timelines. Concerns included side-effects and barriers to treatment. Conclusions: Further confirmation and investigation of Nepali common-sense hypertension models in a sample size sufficient for factor analysis is warranted for effective adherence interventions.Keywords: Common-sense model; hypertension adherence; illness representations; Nepal

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Effective doctor-patient communication is key to addressing the signifi cant issue of nonadherence to hypertension treatment in Nepal. Common clinical messages about hypertension are evaluated utilizing the framework of the Common-Sense Model of Self-Regulation for their role in shaping the patient models that underlie nonadherent behavior. Clinical communications and practices are recommended: to respectfully elicit and address patient reliance on self-identifi ed symptoms; to accompany warnings of hypertension’s serious consequences with specifi c individual action-plans for durable effects; to emphasize the necessity of long-term continuous treatment without creating fears of dependence and withdrawal effects or burdensome monitoring and counseling; to inform of side-effects while presenting medication as nontoxic and necessary for the body’s maintenance of a healthy balance. By acknowledging the patient as an active agent engaged in self-regulation and by employing culturally consonant concepts (often Ayurvedic), we can encourage accurate patientillness and treatment representations that guide medication adherence.