Media Coverage of New Hypertension Definition Too Positive?

February 27, 2019

Media coverage of the 2017 American College of Cardiology/American Heart Association (ACC\AHA) expansion of the definition of "hypertension" concentrated mainly on the positives at the time of the initial announcement, with little mention of the potential harms, a new analysis suggests.

Australian researchers conducted a cross-sectional analysis of media coverage of the new definition, which was announced in November 2017 and has extended the definition of "hypertension" so as to include 46% of adults in the United States.

The results were reported in a letter published in the February issue of JAMA Internal Medicine.

"The expansion of the hypertension definition proposed in the new US ACC/AHA guidelines has caused great concerns among some in the medical community about how it will capture many healthy people, which could lead to a large increase in workload for doctors from the 'worried well' and unnecessary overtreatment in some," coauthor Ray Moynihan, PhD, a research fellow at Bond University, Gold Coast, Australia, commented to Medscape Medical News.

"Our results showed that the potential benefits of the new definition got a lot more coverage than the potential harms," he said.

For their analysis, the researchers used the ProQuest database to conduct a broad search of English language coverage of the new hypertension definition. That definition was presented during the 2017 AHA Scientific Sessions and was published simultaneously in Circulation and the Journal of the American College of Cardiology. The analysis included 100 unique media stories, mainly from the mainstream consumer media; 15 press releases; and 37 journal articles.

Results showed that media coverage was concentrated immediately after publication of the new guidelines in November 2017. A few stories covered subsequent journal articles that appeared in response to the changes.

Media coverage was largely positive about the expanded definition of "hypertension," with 98% reporting the benefits of the expanded definition, 67% not mentioning any harms, 73% favoring benefits overall, and 98% not mentioning any conflicts of interest, the researchers note.

Moynihan, a former medical journalist with a long-term professional and academic interest in how the media covers healthcare, pointed out that coverage of the subject in peer-reviewed medical journals showed a different picture, with much more coverage of the potential harms than was reflected in the media coverage.

He noted that the media reports were largely based on the first announcement of the new guidelines. He also noted that the concerns that were subsequently conveyed in medical journals may have been regarded by the media as "old news."

Moynihan believes this is a common practice. "News articles covering medical issues only seem to focus on the headline announcements, which are often positive, but in many cases they don't follow up with the downsides, which may take time to surface," he said.

He pointed out that one limitation of the current study was that it included news articles found through a search of just one database, so the researchers probably did not find all relevant articles.

"But our data still suggest that the news media did not on the whole follow the issues around the new hypertension definition being discussed in the medical journals," he added.

In concluding their letter, the researchers state: "In light of moves to reform disease definition processes, our findings suggest a need to improve coverage of expanding disease definitions, particularly when those expanding definitions may cause many people harm."

Asked for comment, the American Heart Association responded with a statement from Robert Carey, MD, University of Virginia School of Medicine, Charlottesville, who coauthored the blood pressure guidelines:

"Practice guidelines are intended to streamline patient care for the best outcomes in public health, while also being mindful of individual needs," he said. "The guidelines outline caveats for treatment in certain populations, and our volunteers and spokespeople have addressed these questions in interviews."

Funding support was provided by a grant from the National Health and Medical Research Council. Moynihan has received support from the National Health and Medical Research Council and serves as a member of the scientific committee for the Preventing Overdiagnosis conference. The other authors have disclosed no relevant financial relationships. The researchers' analysis did not include coverage of the guidelines by Medscape Medical News.

JAMA Intern Med. Published online December 28, 2018. Abstract

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