Do Patients Get Enough Patient Education About Their Blood Pressure?

Taking blood pressure is standard procedure for nearly any healthcare encounter, but it might be lulling some patients into a sense of false confidence about when to access care, according to a new study from the University of Southern California. Experts recommended providers up their patient education game to ensure patients know when to be alarmed by a reading.

Particularly, the researchers found that patients tend to be very confident in their knowledge of clinical best practices for hypertension. But when that knowledge is put to the test, many patients fail to identify when to be alarmed by their blood pressure readings and, consequently, when to access care.

The researchers surveyed just about 6,500 patients, 1,342 of whom had hypertension without comorbidities like heart or kidney disease or diabetes, and 795 who had hypertension with comorbidities. Survey questions assessed whether patients could identify the threshold for normal/healthy blood pressure (BP less than 120/80 mm Hg) as well as their confidence in understanding blood pressure readings.

“Blood pressure is measured every time we go to the doctor as well as the dentist and other medical offices,” Wandi Bruine de Bruin, survey leader and co-director of the Behavioral Sciences program at the USC Schaeffer Center for Health Policy & Economics, said in a statement. “But knowledge about what these blood pressure numbers mean is not being transferred from the provider to the patient.”

On the whole, patient confidence in their understanding of blood pressure far outshined their actual knowledge of the subject. More than half (64 percent) of patients said they were confident they understood blood pressure numbers. However, just over a third (36 percent) correctly identified normal blood pressure at 120/80 mm Hg.

When loosening the threshold a bit to between 120 and 130/80 mm Hg, the proportion of patients who accurately identified normal blood pressure increased to 39 percent.

Overconfidence was more common among the respondents with high blood pressure, although these folks were also more able to accurately identify the normal blood pressure range. Three-quarters of those with high blood pressure without comorbidities said they were confident in their knowledge and 47 percent correctly identified normal blood pressure at 120-130/80 mm Hg.

Among those with high blood pressure and comorbidities, those numbers were 81 percent and 40 percent, respectively.

The researchers posited that because blood pressure readings are such a common occurrence—they happen at nearly every medical encounter—patients have been lulled into a false sense of confidence in their knowledge on the topic.

“We tend to feel more confident about topics that are more familiar.  And blood pressure feels like a familiar topic because it gets measured at pretty much every healthcare visit,” Bruine de Bruin, who is also provost professor of public policy, psychology, and behavioral sciences at the USC Price School of Public Policy, explained. “But if these blood pressure measurements are not explained well or at all, we may develop false confidence.  And that false confidence makes is feel that we know when to seek care, even when we don’t.”

The solution is not to stop measuring blood pressure, but rather to offer more context and patient education when that blood pressure gets measured. Bruine de Bruin’s survey did not assess the reasons why clinicians do not always explain blood pressure readings to patients at the point of care, but it could be that clinicians themselves are desensitized, at least to a reading for Stage 1 hypertension (130-139/80-89 mm Hg).

But offering that context will be important for getting patients in for care, something that isn’t always happening. According to the survey, those who were confident in their knowledge of blood pressure were more likely to seek out care when receiving a reading for Stage 2 hypertension (140 or higher/90 or higher mm Hg), but not so much for Stage 1 hypertension.

But getting medical attention for Stage 1 hypertension is important for good outcomes and staving off Stage 2 hypertension or a hypertensive crisis (higher than 180/higher than 120 mm Hg). The American Heart Association recommends some lifestyle changes for individuals with Stage 1 hypertension and medication for those with Stage 2 hypertension.

“Identifying, treating, and controlling high blood pressure is a major clinical and public health challenge,” coauthor Mark Huffman, professor of Medicine at Washington University in St. Louis, said in the press release. “We know that the earlier patients seek and receive treatment, the better and easier it is to control their blood pressure.”

Offering context and patient education during a blood pressure reading, especially if it is above the normal 120/80 mm Hg, will be key to connecting the dots for patients.