By Roy Benaroch, M.D., Emory University
In November 2017, NBC News, along with many media outlets, reported on new guidelines about hypertension. Eleven professional health organizations had written or endorsed this guideline. Given the importance of high blood pressure as the underlying cause of many other complications like heart, kidney, and eye diseases, it is vital to keep people’s blood pressure at check. But it had many aspects that needed to be reconsidered.
The New Guideline in Hypertension
The guideline had many components, but the media focused on one thing: anyone who had a blood pressure of over 130/80, would be considered hypertensive. According to the previous guideline, 32 percent of US adults were hypertensive. But under the new recommendations, this number raised to 46%, which is almost half of the US adults.
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The reactions to these new headlines were mixed. For example, the Washington Post said that identifying people with high blood pressure could reduce the risk of heart disease or mortality. But the New York Times ran a story in which the new guideline was introduced as a source of fear. They reasoned that fear is not always conducive to a change of lifestyle; more often than not, it leads to overtreatment. According to the Times article, the new guideline was developed based on the results of a study called Sprint Study, published in the New England Journal of Medicine in 2015. Although the study was reliable, it is not clear that the results can be applied to all US adults.
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When are the Results of a Study Applicable to us?
For a study to be applicable to us, it has to be conducted on people like us. The Sprint Study was conducted on people who were already at extra-high risk of disease. The population of the study consisted of people over the age of 75 or people who already had heart or kidney disease, or other risk factors contributing to higher risks of illness. Also, the study only recruited people with a 15% risk of cardiovascular disease for ten years. So, according to these criteria, the study was not applicable to most US adults with hypertension because most of them don’t have these risk factors.
The Points that the Study had Missed
The Times story pointed out another important issue. The new definition of high blood pressure made the lower limit go further downward. So, at the bottom of the scale, a new group would emerge that have relatively mild elevations. All these new patients are recommended to change their lifestyles as a treatment. So, they are advised to exercise more, quit smoking, eat healthily, and the like. These are the recommendations that doctors make to anyone anyway. So why was the guideline changed in the first place?
Following that, other professional organizations started to raise doubts about this guideline. For example, the American Academy of Family Physicians announced that they would follow the previous guideline. They argued that the Sprint Study did not consider the studies with opposite results. Also, lowering the threshold had many possible harms like increased side effects of medications and an increased number of people who had conditions that needed medical treatment. The most important reason was that the principal researcher of the Sprint Study was selected as the chairman of the committee that developed the new guidelines. This could raise conflicts of interest among the authors of the new recommendations.
A curious fact is that when the new guideline was released, it attracted massive media attention. But, one month later, when the AAFP refused to endorse the guideline, it received very little coverage. However, these differences of opinion fade over time since new organizations give their opinions, and the disagreements are settled.
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So, when a new health guideline is introduced, we need to decide what to accept and what to reject. Sometimes a recommendation is based on studies that do not have enough evidence. On the other hand, although a study is based on robust evidence, professionals are divided about the results. We need to focus on what makes sense and wait for studies with more solid evidence based on the scientific method. So, if we always have our skeptic toolbox at hand, we can protect our health better.
Common Questions about How Media Coverage Led to Increased Cases of Hypertension
The treatments for hypertension include medication and lifestyle changes. The patients need to do physical exercise, eat healthily, and quit smoking.
Lowering high blood pressure depends on the intensity of the illness. If your blood pressure is very high, you need to take medication. But if it is not very high, you can lower it through making changes in the lifestyle, including exercise and a healthy diet.
High blood pressure can cause many other complications. It can lead to other disease like heart disease, kidney disease, and eye disease.
The Sprint Study randomized over 9300 people with high blood pressure into two groups, one receiving standard care to achieve systolic blood pressure (that’s the top number) of 140 or less, and the other receiving more intense care to keep their systolic blood pressure under 120.