1 in 30 - rethinking blood pressure, risk and motivation

My name is Sanjay Gupta, I'm a cardiologist in York, another beautiful summer's evening in Yorkshire. So today's video is entitled 1 in 30, Rethinking Blood Pressure, Risk and Motivation. So yesterday I heard a very eloquent speaker talk about one of the great challenges in medicine, non-compliance with antihypertensive therapy. So this speaker is a colleague, I have a lot of respect for him, he is an exceptional cardiologist and he knows a ton about blood pressure. And basically he was bemoaning the fact that people do not comply with their blood pressure medication and he quoted a striking figure. He said that 50% of patients stopped taking their blood pressure medications within a year and he seemed genuinely baffled. Why? Don't they know how important it is? And then he gave a number, the NNT or number needed to treat. He said, did you know that if you treat 30 people for high blood pressure you prevent one major cardiovascular event? The NNT is 30. And I paused because while he meant this to sound compelling it made me think about the other 29. What does NNT really mean? Let's unpack that for a moment. If the number needed to treat is 30 that means only one person in 30 actually derive a benefit. A heart attack prevented, a stroke averted, a life saved. But here's the twist. That person never knows it. The one who benefits lives on unaware of the bullet that they dodged. The 29 who didn't benefit, well they still took the tablets religiously. They still face the side effects, the fatigue, the dizziness, the costs, the worry without ever getting a benefit. Without ever feeling a benefit. So when we say why don't patients comply, maybe the real question is have we helped them understand the trade-off? I think there is a more human way to motivate. Here's a thought. Instead of trying to frighten people with statistics, what if we focused on showing them evidence of damage already done? Because seeing is believing. I truly believe that high blood pressure is not a cut, a number that has been decided. You know it's not like oh the whole world has to be categorized by a certain number decided by a bunch of experts. High blood pressure to my mind is that blood pressure that causes harm to that patient. And therefore if you can show the patient signs of harm at a microscopic level, then you know you motivate them. So if you can show them signs of left ventricular hypertrophy on a heart scan. So left ventricular hypertrophy basically means that the heart is more muscular. Why is it more muscular? Because it's working harder. Why is it working harder? Because it's working against a higher pressure. So if you can show a patient that or if you can show that their kidneys are beginning to leak out protein, which they shouldn't do, or if you can show that at the back of their eyes they're developing microscopic damage, then that threat becomes real and personal and tangible. It is no longer a distant number. It is that patient's heart, that patient's kidneys, that patient's eyes. And that can change everything. So I cannot overstate the role of empathy and understanding. Most patients are not non-compliant because they are reckless. They're tired. They're confused. They are overwhelmed. They don't feel the benefit. They just feel the burden. If we want better outcomes, we have to do more than just prescribe. We have to educate. We have to listen and make risk visible and meaningful. We have to move away from fear-based messaging to compassion-driven conversations. We measure blood pressure because we believe it matters. But maybe we also need to measure understanding, motivation and trust. Because a pill only works if someone takes it. And someone only takes it if they believe in it. So we need to give people something to believe in. I hope you found this useful.