NEW YORK CITY, NY — One-third of videos on YouTube related to hypertension and blood pressure provide inaccurate information, according to a new analysis[1]. These misleading videos promoted the use of unproven therapies and questionable supplements, such as acupuncture, L-arginine supplements, and even garlic, for the treatment of hypertension.

"In residency last year, I worked in the hypertension clinic, and this has been an area of interest for a while," Dr Nilay Kumar (Cambridge Health Alliance, MA) told heartwire . "We would see a lot of patients show up with information they obtained on the internet. My conclusion at the time was that what they saw on the internet was oftentimes misleading, was not recommended by the clinical guidelines, and was not considered the standard of care. I thought it would be an interesting idea to look at what percentage of information on YouTube is accurate."

Dr Nilay Kuma

Kumar, who presented the results at the American Society of Hypertension (ASH) 2014 Annual Scientific Meeting , said they chose YouTube because it has a massive user database and almost zero moderation. Individuals are free to upload content onto the website regardless of its accuracy. In addition, they chose the popular video-sharing site because video is an effective means of communication and is more likely to influence patient's behavior than an article alone.

In a search for hypertension and high blood pressure on YouTube, more than 300 000 videos were returned. The researchers studied the 400 most relevant or highly ranked videos. Although the algorithm for ranking videos is proprietary, YouTube assigns a higher degree of relevance if there is a large amount of viewer interaction. "So what might be relevant based on the number of views, the number of comments, or the number of 'likes' might not necessarily be scientifically accurate," said Kumar.

In the study, two physicians classified the videos as "useful," "misleading," or "based on patient experiences" and graded them on an objective, five-point ordinal scale for quality and reliability. In assessing the videos, the physicians considered the content related to epidemiology, pathogenesis, symptoms, lifestyle modification, treatment, and alternative treatments.

Of the videos, 33% were classified as misleading, 64% were classified as useful, and 3% were based on a patient's personal experience. The majority of the misleading videos advocated the use of alternative treatments for hypertension or appeared to misunderstand currently accepted standards of care, such as antihypertensive medications. Other misleading videos were disparaging of guideline-recommended therapies for hypertension, while others made inaccurate statements.

"Among the alternative treatments, the things we saw included acupuncture, acupressure, novel massage techniques, and certain supplements, such as garlic," said Kumar. "Patients are trying all these things. They're trying them in the hope that they might work. However, there is no strong evidence for any of them."

The most commonly promoted alternative therapy for the treatment of hypertension was L-arginine, but there is no evidence that it reduces blood pressure and it's not recommended by the clinical guidelines, said Kumar.

The researchers also examined the source of the videos. The useful videos were significantly more likely to be produced by an academic medical center or professional organization, such as the American Heart Association or ASH. Videos produced by health information websites or government organizations, such as MEDLINE from the National Institutes of Health, as well as those produced by physicians or healthcare workers, were reliable sources. Independent users uploaded 81% of the misleading videos.

Paging Dr Google!

To heartwire , Kumar said that when he worked in the hypertension clinic, there were patients armed with all sorts of medical information. While the "health literacy" of patients varied, even motivated patients, those who take a very active role in their health and treatment, can have trouble discriminating between reliable and unreliable sources, he said.

Kumar recommends that physicians recommend trustworthy websites and sources of medical information, just as they would prescribe a diuretic or calcium-channel blocker for hypertension.

"We should advise patients to trust only reliable sources of information or easy-to-understand sources of information, such as MEDLINE Plus, which is a patient-specific website," he said. "As professionals we need to realize that even when we're not working and when our patients don't have access to us, Dr Google is always on call. With 87% of the US population having internet access at home and 58% with a smart phone, it's a huge amount of people who have the internet at all times. Instead of discouraging them from obtaining this information online, we need to use this technology to our advantage."





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