Control of hypertension – should doctors roll up their sleeves or open their minds to new forms of communication?

Keywords

hypertension, control, media

Introduction

Hypertension, the strongest risk factor for cardiovascular disease, is the main reason for visits to doctors’ surgeries around the world. In spite of the high and constantly growing frequency of patient visits, new medicines and diagnostic devices as well as further and improved guidelines developed by expert groups, the effectiveness of treatment of hypertension is not satisfactory. The consequence of this is high rates of organ complications in the form of heart attacks, strokes, and circulatory insufficiency.

In 2015, the global prevalence of hypertension was estimated at 1.13 billion, including over 150 million in Central and Eastern Europe [1]. The incidence of hypertension has also increased among children, adolescents and young adults; moreover, the control of this group is worse than among older people who are more aware of the consequences of the disease. Based on data from the National Health and Nutrition Examination Survey (NHANES; 1999–2014), covering 41,331 participants aged ≥18, it was shown that young adults (18–39 years), compared to middle-aged adults (age 40–59 years) and the elderly (≥60 years), had a lower awareness, worse treatment and worse control of hypertension [2].

Unfortunately, a systematic patient education programme for hypertensive persons does not exist in any country. Only seasonal educational campaigns have been organised globally since 2005 such as the World Hypertension Day and short-term local educational campaigns related to scientific research. These campaigns have had some positive effects, but they are not enough. Controlled hypertension in patients increased from 50.0% in 2004–2010 to 55.5% in 2011–2012 and towards 57.6% in 2013–2014 [3].

Awareness is developing slowly

Treatment of hypertension is a difficult task for both doctors and patients: for doctors, because the success of the treatment depends to a large extent on the patient’s motivation and discipline; for patients, regardless of which profession or scientific title they have, because they rarely realise how much depends on them and how important awareness of the insidious nature of this disease is.

What are the reasons for the discrepancy between the fact that hypertension is increasingly widespread while the results obtained by individual patients are not always satisfactory?

Good compliance is obtained when a treatment is simple and effective, does not have side effects, and when the reason for the treatment is obvious to the patient. We have a few medical situations in which all of these conditions are met and obvious to the patient, a classic example of which is contraception. However, in today’s perception preventing pregnancy and preventing organ damage complications caused by hypertension are very far apart in terms of effectiveness.  .

Is it possible to find a common path or a set of tools that will work equally effectively? We know that the media is a powerful tool to guide people towards different goals. Can such a goal be to encourage better control of hypertension?

The awareness and control of hypertension has developed very slowly, not only among patients but also among doctors and other medical professionals. It was not until the 1960s and 1970s that large clinical trials such as the Veterans Administration Study and Framingham Heart Study showed that elevated blood pressure is a harmful condition for the body, not an innocuous compensatory response as previously thought.

Despite the support of scientific evidence, these results were not immediately accepted by everyone.

Physicians are perceived as the main and most reliable source of providing information about the disease for patients during an office visit. However, since 1998, sources of information on diseases have additional support, or if you prefer competition, in the form of “Dr Google”, and different types of media.

A national survey undertaken in Canada in 2005 showed that 34% of respondents had been diagnosed with high blood pressure or hypertension but only 44% were able to identify their own blood pressure [4]. The respondents had a poor understanding of the consequences of high blood pressure or hypertension. The majority were unaware of the association between hypertension and heart disease (80%), heart attack (66%), kidney disease (98%) and premature death (74%). Respondents also had limited knowledge of lifestyle issues affecting hypertension, despite 44% indicating that they were overweight and 18% identifying themselves as smokers. Almost two thirds (63%) believed that hypertension was not a serious medical condition.

A questionnaire concerning knowledge and awareness about blood pressure and hypertension was sent to a random sample of 1,000 subjects living in the municipality of Silkeborg, Denmark [5]. Among the investigated group, 43% of responders had self-reported hypertension. The people with self-reported hypertension were older and often had a family history of hypertension. More than 60% reported that untreated hypertension may cause heart disease or stroke. More than half of the responders did not know their blood pressure, and only 21% knew that hypertension can occur without symptoms.

The impact of the campaign in the media implemented over three months to raise public awareness of hypertension was examined [6]. After the campaign, the percentage of participants who knew their blood pressure levels increased from 47.8% to 54.8% and the percentage of those who were aware of the optimal blood pressure levels increased from 51.8% to 58.6% (p<0.001).

The positive, statistically significant (p<0.05) influence of education by the media was found in terms of the awareness of hypertension in patients living in a city in which education had been conducted compared to a control town in which education had not been conducted [7].

Who knows the full power of the influence of social media?

Media can be classified into four types: print media (newspapers, magazines), broadcast media (TV, radio), outdoor media (banners, posters, murals) and the internet. All media have advantages and disadvantages, but the advantages outweigh the disadvantages. The politicians know this best; journalists and their publishers also share this knowledge. In addition to acknowledging the power of the media, it is necessary to know which language should be used to reach the recipient.

The technological revolutions of the 1990s changed the rules of creating and transmitting messages – thick books and long articles are not widespread carriers of information, but tweets and memes are. Metaphors were previously used with good results in the descriptions of cancer or AIDS, so it would be worthwhile to utilise this means of expression in the case of hypertension.

Are healthcare professionals aware of the power of the media?

We do not have systematic scientific research on this subject. This issue was investigated in a survey among professors and researchers at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, USA [8]. An online questionnaire containing 30 questions on social media such as Facebook, Twitter, and blogging was sent by e-mail.

A total of 181 (19.8%) of 912 professors and researchers responsed. The majority of respondents rarely used major social media platforms. Of these 181 respondents, 53.6% had used YouTube, 46.4% had used Facebook, 30.4% had read blogs, and 6.6% had used Twitter in the prior month. More recent degree completion was the best predictor of higher usage of social media. In all, 67.4% agreed that social media is important for disseminating information, whereas only 30.4% agreed that social media is useful for their research, with 23.8% saying that social media was helpful for professional career advancement, whereas 39.8% said it was not. Only 23.8% of faculty said they would employ a full- or part-time social media consultant, and 16.6% currently employed one.

Meanwhile, young people in whom the percentage of hypertension is growing, spend many hours on social media. The language in which they describe their illnesses differs from the scientific language, and often employs metaphors [9].

Business and political organisations use influencers to promote their products or ideas [10]. Health is no less important than political ideas or new products and can certainly be promoted with the participation of influencers via social media. Social media has a positive impact on health problems, a fact which has been confirmed not only by descriptive studies but also by randomised clinical trials [11]. However, the spread of knowledge about hypertension in social media is relatively small compared to the spread of hypertension in the population of all countries. Only 187 hypertension-related Facebook groups containing 8,966 members were found in 2015 [12]. In comparison to other Facebook groups, the number of users interested in hypertension is intriguingly small.

The first professional analysis of the content of articles published in popular media regarding risk factors appeared in the 1990s [15]. To date, there are relatively few such analytical articles, mainly focusing on the analysis of the harmfulness of cigarette smoking and alcohol consumption.

The disturbing discrepancy between the declaration of hypertension awareness and the real health behaviour of patients [13,14], should lead us to seeking new strategies in approaching hypertension. Continuous education with the use of the media should be one of them.

Conclusions

• The informational potential of various types of media is very great. The current use of media to increase the control of hypertension is relatively small.
• Large-scale media studies covering different languages and social cultures are needed to show how the risk factors of hypertension are described in different media and countries.
• Social media has the greatest potential because of its widespread distribution and free access. However, it is not very popular in academia.
• A well thought out and planned greater involvement of medical professionals in the promotion of hypertension control via the media is necessary.
• Education about hypertension risk factors should be conducted primarily via high circulation traditional press and social media. Education on a large scale should be supported by legal regulations on preferential prices of healthy food.
• We should inspire the community of doctors in all countries to spread knowledge about hypertension with slogans using the language of the media. What slogans should we use? Simple ones, but acting on the imagination, for example:
  • “Save a life today from the terrible complications of hypertension - Click here and learn how!”

So, the answer to the initial question is not whether we should roll up our sleeves or open our minds to new types of information about hypertension - we should do both!