A diagnosis of high blood pressure can be a powerful reason to start taking medication, but it may not have the same effect on diet, exercise and other daily habits.
New research found an unexpected gap between people’s willingness to use prescribed medicine and their willingness to make lifestyle changes that can also protect the heart.
The study was conducted by researchers from three universities and included scientists from the Annenberg Public Policy Center at the University of Pennsylvania. The work, led by University at Buffalo communication researcher Yotam Ophir, was published in Hypertension.
Hypertension means blood pressure stays too high over time. Because people often have no warning symptoms, many do not realize they have it until it is found during a medical check or after health problems have already developed.
Long-term high blood pressure can damage arteries and force the heart to work harder. It can increase the chance of stroke, heart attack, heart failure, kidney problems and damage to the eyes, which is why controlling it is so important.
For many patients, treatment has two major parts. Doctors may prescribe blood pressure-lowering medicine, while also recommending changes such as being physically active, eating nutritious foods, reducing salt and keeping body weight in a healthy range.
Both approaches can matter, but they ask very different things of a patient. Swallowing a pill at a regular time is a specific action, while changing diet or exercise can involve dozens of decisions every day and may affect family life, shopping, cooking, work and social activities.
The researchers examined responses from 1,398 American adults selected to represent the national population. They compared people’s intentions to follow health care advice and examined the beliefs that might influence those intentions.
To do this, the team used the Health Belief Model, an approach researchers have used for decades to understand health decisions. It considers questions such as whether people feel vulnerable to a disease, whether they think the disease is serious, whether they believe treatment will help and whether they face barriers to acting.
These beliefs did a fairly good job of predicting people’s intentions to take blood pressure medicine. In fact, the model was about two to three times better at explaining medication intentions than it was at explaining intentions to make healthy lifestyle changes.
Having a hypertension diagnosis was linked with a greater willingness to follow a health professional’s recommendation to take medication. People who were worried about their diagnosis or strongly believed in the benefits of treatment were also more likely to intend to take medicine.
But researchers found almost the opposite pattern for healthy habits. Adults who had already been diagnosed with hypertension reported lower intentions to follow recommendations involving exercise, diet, body weight and salt reduction.
The relationship remained even after the researchers accounted for people’s willingness to use medication. This suggests that the weaker interest in lifestyle changes was not simply because some patients were generally less willing to follow medical advice.
One explanation may be that medication feels like a direct medical treatment, while lifestyle advice can seem harder to put into practice. A person may understand perfectly well that exercise is useful but still struggle to find time, energy, transportation, a safe place to exercise or a routine that can be maintained.
Food changes can present similar challenges. Healthy options may cost more or be harder to find, cultural and family eating patterns can be deeply established, and reducing salt can require changes to both home cooking and packaged or restaurant foods.
The study also found that communication can make a difference. People who experienced greater barriers when discussing health information with doctors or other providers were generally less likely to say they intended to follow treatment recommendations.
This could mean that simply warning patients about the risks of high blood pressure is not enough. Health professionals may need to ask what makes a particular change difficult and help patients develop smaller, realistic steps instead of relying only on general advice.
The findings have broad importance because hypertension is extremely common. It affects more than 100 million adults in the United States and roughly one billion people worldwide, yet many people still do not have their blood pressure adequately controlled.
The study should not be interpreted as proof that people with hypertension refuse to take care of themselves. The researchers measured stated intentions, not actual behavior, and many social, financial and practical factors that influence lifestyle may not be fully captured by a traditional health-belief model.
Because the research was based on survey data, it also cannot show that receiving a hypertension diagnosis directly causes weaker motivation for healthy habits. Future studies will need to examine what happens after diagnosis and which types of support actually help patients make lasting changes.
Still, the results reveal an important weakness in a common approach to health communication. Telling people that a disease is dangerous and that treatment is beneficial may encourage medication use, but it may be far less effective when the treatment requires major changes to everyday life.
The study therefore points toward a more flexible approach to hypertension care. Medicine and lifestyle change should both remain important, but helping people exercise, eat better or reduce salt may require practical coaching, better communication and support tailored to the realities of each person’s life.
If you care about high blood pressure, please read studies about what to eat and to avoid for high blood pressure, and 12 foods that lower blood pressure.
For more health information, please see recent studies about the connection between potato and high blood pressure, and how to eat your way to healthy blood pressure.
Source: University of Pennsylvania.
