Skip to main content

VUMC team devises ‘novel’ idea to help improve hypertension education

Jun. 7, 2018, 9:04 AM


by Kristin Smart

Reading a comic book may improve the health of hypertension patients, or at least that’s the goal of a new study at Vanderbilt University Medical Center.

The ‘Cardiac Crusaders’ graphic novel was created to help improve the health of hypertension patients.

According to the Centers for Disease Control and Prevention (CDC), about one in three U.S. adults, or approximately 75 million people, have high blood pressure. However, only 54 percent of them have it under control.

The ‘Cardiac Crusaders’ graphic novel was created to help improve the health of hypertension patients. Mary Gwyn Bowen, RN, BFA, MA and Carla Beals, MEd, hatched the original idea for the comic book and invited the rest of the VUMC team to assist in development

The graphic novel will be used to help improve health literacy among African-American male patients between the ages of 16 and 35 who have been diagnosed with hypertension. For six months, nurse researchers will follow 15 patients who enroll in the study.

“We have a large population of hypertensives in young black men and we have the data of poor follow-up and poor blood pressure control. So, the question was, are there tools that can be used to control, to convince, to treat them to be more interested in their blood pressure? And we had this kind of ‘aha’ moment — to come up with a graphic novel/comic book concept around blood pressure, superheroes and blood pressure medicines and villains,” said Andre’ Churchwell, MD, professor of Cardiology, Chief Diversity Officer at VUMC and the graphic novel’s illustrator.

“We know there is a renewed interest in comic books and the action concept. So, we took the idea of translating blood pressure medication in the characters, superhero characters, and creating some level of action for a story, but imbedded in the action and the story are lessons about blood pressure,” Churchwell said.

It took one year to complete the plot and illustrations of the graphic novel, which tells the story of a young man named Kevin who feels he is perfectly healthy even though he has high blood pressure. It is a familiar story for many hypertension patients.

Andre’ Churchwell, MD

“Two of the biggest problems with the patient population are that because they don’t have any symptoms, they don’t feel like they need medication. The other problem is salt intake. Those two seem to be the recurring themes,” said Nancy Wells, DNSc, RN, research professor at the Vanderbilt University School of Nursing.

Kevin is faced with tackling the villain, High Blood Pressure Monster, without medication. Can he survive, or will he recruit the help of ‘superhero’ medications, also known as Cardiac Crusaders?

“I have not ever done anything like this before, but it was probably the most fun thing I have done in years,” said Elizabeth Card, MSN, RN, nursing research consultant and a contributing author to the novel.

Nancy Wells, DNSc, RN

Even though the novel provides humor, it delivers an important message.

“The most important thing for these patients to understand is what high blood pressure is doing silently to their bodies; those with hypertension don’t “feel” any different. This is why we call it the silent killer, and it really is,” Card said.

“Rates of hypertension in African-American males are higher than for other men. And untreated hypertension in these patients creates worse consequences. If you have a stroke, it isn’t mild; it is more severe,” said Churchwell.

The study enrollees will be followed during their graphic novel education. Nurses will help them with this new tool and chart progress.

Elizabeth Card, MSN, RN

“We’re going to do a six-month post-data pull to see if we can improve the thing we’re really interested in, which is compliance,” Card said. “Are they showing up for their appointments? Are they getting their medications filled? Does their blood pressure look better?”

If the graphic novel proves successful, there may be an animated version and possible spinoffs of the Cardiac Crusader characters.

The study was funded by a grant from the Center for Effective Health Communication.

For more information on how you can enroll, please contact Elizabeth Card at

Recent Stories from VUMC News and Communications Publications

Vanderbilt Medicine
VUMC Voice