Google, YouTube, iPhones and the Affordable Care Act are featured in new research for their role in the hypertension epidemic
Considered the "silent killer," high blood pressure affects approximately one billion people worldwide, including one in three adults in the United States. From May 16 - 20, 2014, hypertension healthcare providers and researchers from around the world will gather at the 29th Annual Scientific Meeting of the American Society of Hypertension (ASH) in New York City to discuss new scientific findings, state-of-the-art diagnostic tools and new treatments for hypertension. During the conference, more than 200 new studies about the epidemic will provide the most up-to-date information about how to prevent, diagnose and control hypertension and its associated cardiovascular diseases.
Among the findings from the ASH meeting is research that suggests the Affordable Care Act may help ensure that millions more Americans will have hypertension treatment options; quantifies the reliability of hypertension videos posted on YouTube; evaluates the downsides of iPhone blood pressure monitors; examines why some people crave salty foods; and analyzes seasonal internet search results for information about hypertension. In addition to the new research, information on national and international hypertension guidelines and renal denervation will be presented.
Domenic Sica, M.D., ASH President-Elect and 2014 Scientific Program Committee Chair adds, "The ASH meeting brings together the world's best critical thinkers and scientists in clinical hypertension so we can collaborate on providing the highest level of care for patients with hypertension today and work toward improved treatment and patient outcomes for the future."
Use of YouTube and Google to Search and Find Accurate Hypertension Information
The Internet has made it possible for anyone to claim to be an "expert" and offer health information to the masses. Nilay Kumar, M.D., attending physician at Cambridge Health Alliance in Cambridge, Mass. and instructor in Medicine at Harvard Medical School, along with other researchers, worked to determine how much of the hypertension information present in YouTube videos is scientifically correct and whether people are finding and viewing that correct information.
Using the search terms "hypertension" and "high blood pressure," the researchers evaluated videos for conformation to current hypertension guidelines and graded videos on a five-point scale for quality and reliability. Of the 176 English-language videos screened, the results found that 64% were classified as useful and 33% were misleading. Of the misleading videos, two-thirds advocated unproven treatments and questionable supplements not supported by scientific evidence. However, median number of views, views per day and "likes" were lowest for useful videos. With more than 1 billion users, video-sharing websites such as YouTube could provide a powerful platform for the dissemination of accurate medical information. However, given the predominance of entertainment-focused material such as baby animal and music videos, viewers should exercise caution when pursuing medical information on YouTube.
In a related study, Kumar and colleagues examined Google search trends for the terms "hypertension" and "high blood pressure" in the United States and Australia from 2004-2013. With the results, the researchers compared the highest and lowest monthly search volumes and then used mathematical modeling to determine seasonal variations. Results found that in the U.S., the search for hypertension was highest in February and lowest in August while in the Southern Hemisphere, the search was highest in August and lowest in January. This finding aligns with multiple studies that have shown blood pressure has seasonal variations, increasing in winter and decreasing in summer. The findings of this study provide a novel perspective for hypertension surveillance and suggest that Internet search volumes could be used as an adjunct to traditional surveillance mechanisms, especially in resource limited settings.
Study: Assessing Patterns of Global Interest in Hypertension Using Internet Search Engine Data, N. Kumar, C. Phipps, N. Garg, A. Pandey; Medicine, Cambridge Health Alliance, Cambridge, MA, Mathematics, University of Waterloo, ON, CANADA, Medicine, BIDMC, Boston, MA, Medicine, UTSW, Dallas, TX.
Study: Are Video Sharing Websites a Useful Source of Information on Hypertension? N. Kumar, N. Garg, A. Venkatraman, A. Pandey; Medicine, Cambridge Health Alliance, Cambridge, MA, Medicine, BIDMC, Boston, MA, Medicine, UAB, Birmingham, AL, Medicine, UTSW, Dallas, TX.
Masked Hypertension May Result in Missed Opportunities to Prevent Hypertensive Heart Disease
Many patients unknowingly have what's called "masked hypertension," a condition whereby they have normal blood pressure readings in a hospital or clinic, but their pressure is elevated during normal living conditions. This type of hypertension is often associated with left ventricular hypertrophy and therefore is extremely important to detect and treat.
A recent study found that masked hypertension was nearly twice as prevalent (11.9%) among untreated blacks as untreated whites (6.8%). But it was also found to be common among both whites (17%) and blacks (20%) currently being treated for hypertension. What's more, these researchers found that high blood pressure at home was more predictive of left ventricular hypertrophy than high blood pressure in a clinic. The study's authors suggest that home blood pressure monitoring may be an important tool for diagnosing and providing appropriate treatment of hypertension and for the prevention of hypertensive heart disease.
In this study, researchers from Cedars-Sinai in Los Angeles and the University of Texas Southwestern Medical Center, among other institutions, evaluated the effectiveness of home blood pressure monitoring among non- Hispanic black and white men and women. The study included 917 untreated blacks versus 735 untreated whites, as well as 345 blacks being treated for hypertension and 193 whites being treated for hypertension.
Study: Masked Hypertension by Home Blood Pressure Monitoring in Blacks: Missed Opportunities to Prevent Hypertensive Heart Disease, F. Rader, S. Franklin, R. Haley, N. Li, R. Elashoff, R. Victor; Heart Institute, Cedars-Sinai, Los Angeles, CA, Heart Disease Prevention Program Department of Medicine, UC Irvine, Irvine, CA, Department of Internal Medicine/Division of Epidemiology, University of Texas Southwestern Medical Center, Dallas, TX, Department of Biostatistics, School of Public HealthHeart Institute, UCLA, Los Angeles, CA, Department of Biostatistics, School of Public Health, UCLA, Los Angeles, CA.
iPhone and Other Home Blood Pressure Monitoring Devices Often Lack Accuracy and Reliability
Smartphones are helpful for directions and checking email, but research proves the same is not true for measuring blood pressure. According to research presented by Clarence E. Grim, M.D., of High Blood Pressure Consulting in Stateline, Nev., home blood pressure devices often produce errors that are more than 5 mmHg too high or low for about half of the individuals that use them. And, some home monitoring devices may provide a measurement error of as large as 40/20 mmHg. Grim tested the validity of reading from the iHealth Blood Pressure Dock and the Withings Home BP device, both for use on the iPhone. At each sitting, five readings were taken with each device, with 30 seconds rest between each reading. The same person used both devices for more than three months.
Of the 112 readings tested, the iHealth read the systolic an average of 5.3 mmHg and the diastolic 3.3 mmHg higher than the standard auscultatory method. The Withings monitor read the diastolic pressure lower than the standard auscultatory method by 5.3 mmHg. A 5 mmHg difference may seem insignificant, but this error at the 90-95 mmHg range would miss 21 million cases of hypertension in the U.S. alone. Dr. Grim and other leading researchers are advocating for stricter standards for manual, electronic or automated blood pressure manometers.
Study: Home blood pressure devices for the iPhone do not get the same readings on the same person, C. E. Grim; High Blood Pressure Consulting, Stateline, NV.
Health Insurance Makes A Difference in Controlling High Blood Pressure
Currently, nearly half of people with hypertension do not have their blood pressure controlled. New research shows that the Affordable Care Act may play a role in reaching the U.S. Department of Health and Human Services' Healthy People 2020 goal of achieving blood pressure control in more than 61% of people with diagnosed hypertension.
Research presented by researchers at the University of South Carolina School of Medicine - Greenville found a dramatic increase in the number of 18-64 year-olds with diagnosed hypertension who are uninsured, as well as a growing gap between the insured versus uninsured Americans as it relates to controlling hypertension. Using data from the National Health and Nutrition Examination Survey from 1988-2010, the researchers reported a 15.6 million increase in the number of patients diagnosed with hypertension. And, in 2010, only 29.8% of the uninsured had their blood pressure controlled compared to 52.5% of those with medical insurance (public or private). The researchers also found that there were no differences between those with public or private insurance on blood pressure control. "As more Americans get health insurance, as part of the Affordable Care Act, we may see a significant increase in the number of individuals who will have more treatment options to control their disease," said B.M. Egan, of the Care Coordination Institute in Greenville, S.C.
Study: The Growing Gap in Hypertension Control between Insured and Uninsured Adults: NHANES, B. M. Egan, J. Li, J. Smalls, P. J. Nietert, A. Sinopoli; Care Coordination Institute, Greenville Health System, Greenville, SC, Mathematics, College of Charleston, Charleston, SC, College of Graduate Studies, Medical University of South Carolina, Charleston, SC, Public Health Sciences, Medical University of South Carolina, Charleston, SC, Care Coordination Institute, Grenville Health System, Greenville, SC.
Individuals with Hypertension Prefer Saltier Foods
It's well-known that diets rich in sodium increase one's risk for hypertension, yet sodium consumption is generally about 3,000 mg per day or twice the recommended limit of 1,500 mg for those older than 50 years of age or anyone at risk for high blood pressure. Patricia T. M. Villela and other researchers from the University of Sao Paulo studied 118 adults to determine if hypertensive people prefer saltier foods and if age makes a difference on salt preferences. Four groups were studied: younger (average age of approximately 38 years old) with or without hypertension; and older (average age of about 72 years old) with or without hypertension. The researchers gave the subjects French bread with three different concentrations of added salt. After two weeks, the researchers retested the subjects but seasoned the bread with oregano plus three different concentrations of salt.
The results showed that both younger and older hypertensive patients preferred higher salt concentrations on their bread. Older individuals with normal blood pressure preferred a medium-salt concentration while the younger individuals with normal pressure preferred the lowest salt concentration. When the bread was seasoned with oregano and the various levels of salt, all groups preferred options with lower or medium concentrations of salt, indicating that the use of naturally sodium-free herbs and spices is a healthful way to help slash salt intake without compromising flavor.
Study: Salt preference in hypertensive and normotensive older and younger individuals, P. T. Villela, E. Ferriolli, E. B. Oliveira, J. C. Moriguti, N. K. Lima, J. M. Bertani, R. T. Bonardi; Medical Clinics, University of Sao Paulo, Ribeirao Preto, BRAZIL.