Storytelling and Blood Pressure

Can viewing culturally appropriate vignettes of someone relating their story regarding chronic health condition management help others manage the same problem?  The answer appears to be yes, at least as concluded by a study in this issue of Annals of Internal Medicine.

People with high blood pressure were recruited by researchers to describe their experiences with high blood pressure management and an interactive DVD series was developed.  Almost 300 patients with confirmed high blood pressure were recruited to receive  these health story DVDs at baseline, 3 and 6 months, or health-related messaging not related to blood pressure.  Blood pressure was assessed at baseline, 3 months, and at the end of follow-up at 6 to 9 months.

Patients who viewed the high blood pressure control stories saw a decrease in their systolic blood pressure (the top, larger number) of over 11 mmHg and their diastolic (the lower, bottom number) blood pressure by almost 6.5 mmHg.  That's huge, Rick and I agree in this week's podcast.  We have reported previously as success stories very modest reductions in blood pressure in the 2-4 mmHg range, so we are very persuaded by this data.

What exactly did study participants with hypertension or high blood pressure modify as a result of viewing the DVDs?  Most unfortunately, this study didn't address that very critical question, so we are left to speculate.  Did they take their medication more vigilantly?  Watch salt in their diet?  Exercise more?  Other important interventions may have included stress reduction techniques such as yoga or meditation, but we simply don't know what these stories persuaded viewers to do.

Here's what we do know:  the people relating the stories were people study participants could relate to, as they were the same ethnicity, socioeconomic group, and often, gender.  The majority of study subjects were women (about 70%) and women relate well to stories told by others, with African Americans particularly suited for this type of communication.  Rick and I both recall the success of an anti-hypertensive strategy for African American men that centered around barbershops, often a place of tall tales indeed  (see previous blog post).

What's extremely good news in my view about this study is it places power in the hands of patients themselves and seems to have found at least one successful strategy for getting them to move from one place to another, in this case from a place of lackluster blood pressure control to much better control.  Anything that can move people to adopt better self health promoting behavior is a win in my book.  (Now if we could only get EVERYONE to embrace the folly of smoking and cease immediately...).

I like the ease of this intervention and the possibilities for employing it via smartphone or other mobile devices, and the fact that it wasn't expensive or troublesome.  Since we know that almost everyone with high blood pressure will require two or more medications to keep it adequately controlled, and that patients frequently complain that they feel worse when their blood pressure is in a desirable range, developing strategies for getting their buy in is critical. Rick and I both look forward to further studies of this ilk.

Other topics this week include use of a specific antidepressant medication for the management of hot flashes related to menopause in JAMA, a new agent for imaging the brain in suspected Alzheimer's disease in the same journal, and the natural history of coronary artery disease in NEJM.  Until next week, y'all live well.

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