This story about new guidelines from the American Heart Association and other medical groups that reduce the threshold for diagnosis of high blood pressure summarizes the key recommendations, but doesn’t explain benefits, harms or costs.
This story (along with those from many other news media outlets) should have addressed the glaring disconnect between what is recommended and what doctors and patients actually do. The story used far lower estimates of the number of people likely to be told to start taking drugs than what was contained in an American Heart Association news release. (And the online and video versions of the ABC News stories used very different numbers.)
Readers of this story learn that they are more likely to be told they have high blood pressure, but not what that means to them, other than that they will probably hear more lectures about diet and exercise, and maybe get more drug prescriptions.
For a good alternative view, see the this New York Times opinion piece.
If almost all of the “new” patients with high blood pressure will be simply advised to improve their lifestyle, by doing things like exercising more, eating better and drinking less alcohol, which are things everyone is advised to do, then what has really changed? Any time that medical experts spout the routine lifestyle advice, reporters should press them to explain what is really likely to change for patients. Will physicians and clinics adopt (and will insurers pay for) more effective lifestyle interventions? Or will it be business as usual for most patients, except that more people will be prescribed drugs?
There is no discussion of cost, either from the increase in the number of people the guidelines say should be taking blood pressure lowering medication, or the costs of instituting effective lifestyle modification programs or of expanded blood pressure monitoring, including having people measure blood pressure for an extended period at home as part of the initial diagnostic process.
The story says people who will now be told they have high blood pressure (based on the expanded definition) have twice the risk of cardiovascular problems of those with blood pressure below the new cutoff. However, the story does not explain what the actual risk is. In other words, twice what? Then, there is the matter of the benefit of following the new guidelines: how much would it actually reduce cardiovascular problems? How many heart attacks prevented or delayed? How many strokes? The story doesn’t discuss these fundamental questions.
By contrast, a story in USA Today noted at the end that “only about half of Americans with hypertension under the old guidelines have it under control, said Whelton, the guideline chair. “I don’t underestimate the challenge of what we need to do.” This statement provides important context by pointing out that diagnosing hypertension often fails to lead to a reduction in blood pressure or any real health benefits that would be expected to follow. ABC News and many other outlets failed to address the disconnect between recommendations about lifestyle and what doctors and patients do in the real world.
There is no discussion of harms in the story. The most obvious potential harm is from medication side effects.
The story reports that these guidelines are the result of an “extensive report by experts” and the first update in 14 years. But it doesn’t explain that guidelines are based on a systematic review of the evidence–and these guidelines should state what the strength of the evidence is for the recommendations. An independent expert likely would have helped explain the quality of the evidence behind this recommendation.
The story doesn’t disease-monger, though it’s up for debate if the recommendation does, since the new guideline dramatically increases the number of people who will be labeled as hypertensive.
We wanted to note that ABC News does not agree with itself about how many more people may be prescribed blood pressure lowering drugs. The online text (byline: Ted Handler, MD) says that about 4.2 million more Americans would be advised to take drugs, about 5 percent more than under the old guidelines. However, in the video clip from ABC World News Tonight, chief medical editor Dr. Jennifer Ashton said “it’s estimated that that number will only go up by 2 percent.”
It’s not clear where either of those numbers came from. The American Heart Association news release about the new guidelines says “Of the estimated 14 percent more adults to be classified with high blood pressure, about one in five will need medication, according to Paul Whelton, M.D., who chaired the guideline writing committee.”
Fourteen percent of the US adult population is about 35 million people, so one in five would be about 7 million more who would be advised to start taking medications, according to the AHA news release. That would be about a 9 percent increase in the number of people advised to take blood pressure drugs, which is a much higher percentage than cited by ABC News.
The story does say that the guidelines are based on “an extensive report by experts without relevant ties to the pharmaceutical industry.” However, there are no quotes from or references to any sources who were not involved in creating the new guidelines.
The story is all about contrasting the new hypertension definition with the old one. However, as noted above, ABC News used far lower estimates than the American Heart Association news release of the number of people who would be advised to take blood pressure lowering medication. And when discussing recommended lifestyle changes, the story did not note that these recommendations apply to everyone, whether or not they have been diagnosed with high blood pressure
Ideally the story would have discussed that other medical groups have suggested different blood pressure guidelines based on age group.
It is obvious that blood pressure testing and treatment is widely available.
The story reports that this is the first update of American Heart Association guidelines on hypertension in 14 years.
The story is less informative than the news release. And, as noted above, some of the numbers in the story do not match those in the American Heart Association news release. However, since we don’t see any evidence of quotes or text taken directly from the news release, we’ll rate this Satisfactory.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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