Abstract
This study examines the media coverage of the expanded definition of hypertension associated with the new guidelines from the American College of Cardiology and the American Heart Association.
Expanding disease definitions are one driver of overdiagnosis and related overtreatment.1 In November 2017, new guidelines from the American College of Cardiology and the American Heart Association (ACC/AHA) expanded the definition of hypertension, extending the label to 46% of adults in the United States.2 The expanded definition was welcomed by some as an important public health initiative; however, other national and international groups, including the American Academy of Family Physicians, did not endorse the expanded definition amid concerns about potential harms.3 Concerns raised included potential overtreatment; intellectual conflicts of interest held by some of the panel members involved with the new ACC/AHA guideline, including members who were connected to a major trial that strongly influenced the guideline; and uncertainty regarding blood pressure measurement methods. A checklist-based analysis found that most people newly classified as hypertensive were unlikely to benefit, but instead could experience harms from being unnecessarily labeled as having hypertension, and some people could experience adverse effects from unnecessary medication.4 We investigated how the media covered the potential benefits and harms of the expanded definition of hypertension.
Methods
We conducted a cross-sectional analysis of media coverage of the expanded definition of hypertension between November 1, 2017, and July 13, 2018. Using explicit terms about guidelines and hypertension, we conducted a broad search of English language stories in the ProQuest database. We also searched ProQuest for press releases and PubMed for journal articles responding to the change. Records were independently screened and were included in the study if they covered the new guidelines or responses to them. Records were excluded if they were duplicates, repeats of news stories syndicated across different outlets, or did not cover the guidelines. A coding tool was developed based on previous media analysis5 and tools used by organizations, including Health News Review (http://www.healthnewsreview.org), and it was used independently by 2 of us (R.N.M. and L.A.). Discrepancies in screening and coding were resolved by discussion among all authors. Primary outcomes were the proportion of stories covering the expanded definition’s potential benefits, potential harms, a balance of benefits and harms, and potential conflicts of interest of members of the ACC/AHA panel. Secondary outcomes included the proportion of stories covering specific evidence supporting the changes, changes to prevalence, costs relating to the changes, uncertainty about blood pressure measurement, and any criticism of the new guideline.
Results
Our searches produced 2309 stories, 932 press releases, and 102 journal articles. After screening and excluding duplicates, syndicated copies, and material not covering the new guidelines, 100 unique stories, 15 press releases, and 37 journal articles were included in the study (a full list of the news stories, press releases, and journal articles is available from the authors). Media coverage was concentrated immediately after publication of the new guidelines in November 2017, with few stories covering subsequent journal articles responding to the changes (Table). Media coverage was largely positive about the expanded definition of hypertension. Of 100 included stories, 98 (98%; 95% CI, 95%-100%) covered the benefits of the expanded definition, 67 (67%; 95% CI, 58%-76%) did not mention any harms, 73 (73%; 95% CI, 64%-82%) favored benefits overall, and 98 (98%; 95% CI, 95%-100%) did not mention any conflicts of interest (Figure). Press releases similarly favored the benefits of the expanded definition, whereas journal articles had more balance, with only one-third (n = 14) favoring benefits overall (Figure). Results for secondary outcomes are reported in the Table.
Table. Media Coverage of the Expanded Definition of Hypertension: Publication Dates and Secondary Outcomes, November 2017 to July 2018.
| Article Characteristics | No. (%) | ||
|---|---|---|---|
| Media Storiesa | Press Releasesa | Journal Articlesa | |
| No. | 100 | 15 | 37 |
| Publication date | |||
| November 2017-January 2018 | 81 (81) | 8 (53) | 10 (27) |
| February 2018-Apr 2018 | 13 (13) | 5 (33) | 17 (46) |
| May 2018-July 2018 | 6 (6) | 2 (13) | 10 (27) |
| Secondary outcomes | |||
| Mention of evidence supporting the changes | 27 (27) | NA | NA |
| Mention about changes to prevalence | 77 (77) | NA | NA |
| Mention about costs associated with changes | 15 (15) | NA | NA |
| Mention of uncertainty with risk prediction tools | 1 (1) | NA | NA |
| Mention of uncertainty with blood pressure measurement | 31 (31) | NA | NA |
| Mention of any criticism of the changes | 35 (35) | NA | NA |
| Mention of AAFP response | 2 (2) | NA | NA |
Abbreviations: AAFP, American Academy of Family Physicians; NA, not applicable.
A full list of the media stories, press releases, and journal articles is available from the authors.
Figure. Coverage by Media, Journal Articles, and Press Releases of the Benefits and Harms of the 2017 Expanded Definition of Hypertension.
The Figure shows the focus of media stories, journal articles, and press releases.
aThe study did not measure coverage of conflicts of interest for journal articles and press releases.
Discussion
In this sample, most media coverage of the 2017 ACC/AHA expansion of the definition of hypertension did not mention important potential harms and did not cover information emerging from the peer-reviewed literature about conflict and controversy associated with the change among influential medical groups. Study limitations include use of the ProQuest database, which does not provide a comprehensive collection of news stories across all forms of media, and the use of English language records only. Strengths include a novel analysis of media coverage of the expanded definition of hypertension, a sensitive search to minimize missing stories, and supplementation with press releases and journal articles. In light of moves to reform disease definition processes,6 our findings suggest a need to improve media coverage of expanding disease definitions, particularly when those expanding definitions may cause many people harm.
References
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