Arlington, Virginia - In a survey to assess treatment preferences for high blood pressure, respondents were more likely to choose a daily cup of tea or a pill over exercise, according to preliminary research presented at the American Heart Association’s Quality of Care and Outcomes Research Scientific Sessions 2018, a premier global exchange of the latest advances in quality of care and outcomes research in cardiovascular disease and stroke for researchers, healthcare professionals and policymakers.
Researchers wanted to find out how people weigh the benefits of high blood pressure treatment options against its inconvenience. They asked survey respondents to imagine that they had high blood pressure and then asked about their willingness to adopt any of four “treatments” to gain an extra month, year or five years of life. In this survey, the “treatments” proposed were: a daily cup of tea, exercise, pills or monthly or semi-annual injections.
Results showed that taking a pill or drinking a daily up of tea were the preferred treatments, though some were unwilling to adopt any intervention even if it meant gaining an additional year or five years of life. For each treatment, participants were more likely to say they would adopt it if the benefit were greater:
79 percent of respondents said they would be willing to take a pill for an extra month of life, 90 percent would for an extra year of life and 96 percent would for an extra five years of life;
78 percent said they would drink a daily cup of tea for one extra month of life, 91 percent would for one extra year of life and 96 percent would drink it for an extra five years of life;
63 percent would be willing to exercise for an extra month of life, 84 percent would for an extra year of life and 93 percent would exercise if it meant an extra five years of life;
A shot was the least preferred of the options – 68 percent would take a shot every six months if it would give them an extra month of life, 85 percent would do it for an extra year of life and 93 percent would be willing if it gave them another five years, but only about half (51 percent) would take a monthly shot for an extra month of life, 74 percent would for an extra year and 88 percent would opt for an injection every month if it gave them five extra years of life.
In addition, at least 20 percent of respondents wanted to achieve gains in life expectancy beyond what any of the individual interventions could provide.
“Our findings demonstrate that people naturally assign different weights to the pluses and minuses of interventions to improve cardiovascular health,” said Erica Spatz, M.D., M.H.S., the study lead author and an assistant professor of cardiovascular medicine in the Center for Outcomes Research and Evaluation at Yale School of Medicine in New Haven, CT. “I believe we need to tap into this framework when we are talking with patients about options to manage their blood pressure. We are good about discussing side effects, but rarely do we find out if other inconveniences or burdens may be impacting a person’s willingness to take a lifelong medication or to exercise regularly.”
From March to June 2017, 1,284 U.S. adults recruited through Amazon MTurk and 100 patients attending an outpatient health clinic completed the survey. Most survey respondents were under 45 years old, and half were female. Roughly three-quarters of respondents were non-Hispanic white, 10 percent were African American, 7 percent were Hispanic or Latino, and 8 percent were Asian. Most had high blood pressure.
A study limitation is that most respondents were relatively young. Since cardiovascular disease is more common among older people, they may have different responses than younger people. Another limitation is that survey respondents were not told the true life-extending ability of each intervention.
High blood pressure is a leading risk factor for heart and blood vessel, or cardiovascular, disease. Yet, it is often called the silent killer because it causes no symptoms. To prevent high blood pressure, the American Heart Association recommends getting regular physical activity, in addition to other lifestyle changes. These changes include eating a healthy diet, limiting alcohol, managing stress, maintaining a healthy weight, and quitting smoking. It is also important to work with a healthcare provider and to properly take medications, if prescribed, to reduce blood pressure.
Co-authors are: Andi Shahu, B.S.; Tamara Kliot, B.S.; Nihar R Desai, M.D., M.P.H.; Darrel P Francis, M.D.; Jeph Herrin, Ph.D.; and Harlan M Krumholz, M.D., M.H.S. Author disclosures are on the abstract.
The Agency for Healthcare Research and Quality Patient-Centered Outcomes Research Institute (Mentored Career Development Program) funded the study.