What Is in a Name?

Abstract

Abstract-Despite major advances in treating hypertension, >50% of all individuals diagnosed with the condition remain in poor control. A fundamental issue may be that patients may not fully understand the meaning of the term hypertension or its cause, leading to poor adherence to medications and limiting other effective self-management behaviors. We posit that the word hypertension itself may contribute to these misunderstandings, particularly in regards to the role of stress in causing hypertension, which thus suggests stress management as a primary strategy for control. The word hypertension is often interpreted by patients to mean too much tension. In conjunction with cultural framings of stress causing high blood pressure, many patients turn to stress management to control their hypertension. The word hypertension can thus cause patients to think of it as more of a psychological than physiological condition, thus discounting the value of antihypertensive medications and interfering with medication adherence. We therefore suggest that clinicians reconsider the use of the term hypertension and the ways in which they explain the condition to patients. Reorienting the language to the more patient-centered term of high blood pressure may help patients better understand the condition and to more readily embrace the available efficacious therapies. The word hypertension is common, even in lay parlance, and the medical establishment often assumes that patients understand what hypertension is and how it affects them. But language is easily interpreted in ways unintended by the speaker. The term hypertension is a prime example of the problem of medical language or jargon being misinterpreted by the lay person. Although the term is used alternately with the term high blood pressure, studies from around the world indicate that patients may not understand the words in the same way as clinicians, and this may have significant implications for medication adherence and ultimately, outcomes.

The Impact of Medical Terminology in Self-Triage Decision-Making

“…Consistent with findings that lay labels are perceived as less severe, less representative of disease, and more prevalent (Young et al, 2008), patients also felt a physician's use of lay labels indicated that the disease was less worrisome and would subside quickly (Ogden et al, 2003). Based on this growing body of work, physicians should also avoid instances where particular labels may be misinterpreted and as a result, undermine treatment (Bokhour and Kressin, 2015). The optimal terminology to be used by physicians in consultations depends on the language used by patients and the intended outcome.…”

“…Ethical issues with regards to language choice arise when language is shown to readily bias perceptions and health behavior intention. Bokhour and Kressin (2015) expressed a similar concern toward potentially misinterpreted disorder labels, like hypertension, suggesting individual labels may carry their own semantic and cognitive biases. Despite being an established medical label for high blood pressure due to elevated arterial tension, hypertension is often misinterpreted as excessive general tension or stress.…”

“…Despite being an established medical label for high blood pressure due to elevated arterial tension, hypertension is often misinterpreted as excessive general tension or stress. Associations between blood pressure and stress, although commonly held, remain controversial and unclear, especially with regards to the etiology and management of hypertension (Bokhour and Kressin, 2015). As a result, patients may rely on psychological stress relief and discount the value of non-psychological interventions like diet, exercise, or antihypertensive medication.…”

“…As a result, patients may rely on psychological stress relief and discount the value of non-psychological interventions like diet, exercise, or antihypertensive medication. The presentation of this medical label, or other potentially misinterpreted labels, may influence self-triage, self-care management, and medication adherence (Bokhour and Kressin, 2015). New medical labels should consider conflicting perceptions of lay labels and potential misinterpretations, as well as the implicit influence of language on perception and decision-making.…”

A Tale of Two Patients

“…The advice given during the hospitalization regarding aftercare and need for medication therapy seems to have been eroded by perceived side effects and information from TV commercials, as well as his own beliefs about his conditions and what might help treat them. This is not uncommon ; patients often hold different views about their conditions and effective treatments than the biomedical model 63, 64 . For example, our and others’ work has revealed that many patients view hypertension as a stress-induced condition which can be remedied by lifestyle changes to reduce stress 54, 63 .…”