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Screening for High Blood Pressure: U.S. Preventive Services Task Force Reaffirmation Recommendation Statement
- U.S. Preventive Services Task Force*
- From the U.S. Preventive Services Task Force, Agency for Healthcare Research and Quality, Rockville, Maryland.
Abstract
Description: Reaffirmation of the 2003 U.S. Preventive Services Task Force statement about screening for high blood pressure.
Methods: The U.S. Preventive Services Task Force did a targeted literature search for evidence on the benefits and harms of screening for high blood pressure.
Recommendation: Screen for high blood pressure in adults age 18 years or older. (Grade A recommendation)
The U.S. Preventive Services Task Force (USPSTF) makes recommendations about preventive care services for patients without recognized signs or symptoms of the target condition.
It bases its recommendations on a systematic review of the evidence of the benefits and harms and an assessment of the net benefit of the service.
The USPSTF recognizes that clinical or policy decisions involve more considerations than this body of evidence alone. Clinicians and policymakers should understand the evidence but individualize decision making to the specific patient or situation.
Summary of Recommendations and Evidence
The U.S. Preventive Services Task Force (USPSTF) recommends screening for high blood pressure in adults age 18 years and older. This is a grade A recommendation.
Rationale
Importance
Hypertension is a prevalent condition that contributes to important adverse health outcomes, including premature death, heart attack, renal insufficiency, and stroke.
Detection
The USPSTF found good evidence that blood pressure measurement can identify adults at increased risk for cardiovascular disease from high blood pressure (Figure; Tables 1 and 2).
*This recommendation applies to adults without known hypertension. For the full recommendation statement and supporting documents, go to http://www.preventiveservices.ahrq.gov.
Benefits of Detection and Early Treatment
The USPSTF found good evidence that treatment of high blood pressure in adults substantially decreases the incidence of cardiovascular events.
Harms of Detection and Early Treatment
The USPSTF found good evidence that screening and treatment of high blood pressure causes few major harms.
USPSTF Assessment
The USPSTF concludes that certainty is high that the net benefit of screening for high blood pressure in adults is substantial.
Clinical Considerations
Patient Population
This recommendation applies to adults without known hypertension.
Screening Tests
Office measurement of blood pressure is most commonly done with a sphygmomanometer. High blood pressure (hypertension) is usually defined in adults as a systolic blood pressure of 140 mm Hg or higher or a diastolic blood pressure of 90 mm Hg or higher. Because of the variability in individual blood pressure measurements, it is recommended that hypertension be diagnosed only after 2 or more elevated readings are obtained on at least 2 visits over 1 to several weeks (1).
Risk Assessment
The relationship between systolic blood pressure and diastolic blood pressure and cardiovascular risk is continuous and graded. The actual level of blood pressure elevation should not be the sole factor in determining treatment. Clinicians should consider the patient's overall cardiovascular risk profile, including smoking, diabetes, abnormal blood lipid values, age, sex, sedentary lifestyle, and obesity, when making treatment decisions.
Screening Interval
Evidence is lacking to recommend an optimal interval for screening adults for hypertension. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommends screening every 2 years in persons with blood pressure less than 120/80 mm Hg and every year in persons with systolic blood pressure of 120 to 139 mm Hg or diastolic blood pressure of 80 to 90 mm Hg (2).
Pharmacologic Treatment
Various pharmacologic agents are available to treat high blood pressure. The JNC 7 guidelines for treatment of high blood pressure can be accessed at http://www.nhlbi.nih.gov/guidelines/hypertension/jncintro.htm.
Nonpharmacologic Treatment
Nonpharmacologic therapies, such as reduction of dietary sodium intake, potassium supplementation, increased physical activity, weight loss, stress management, and reduction of alcohol intake, are associated with a reduction in blood pressure. For persons who consume large amounts of alcohol (>20 drinks per week), studies have shown that reduced drinking decreases blood pressure.
Discussion
In 2003, the USPSTF reviewed the evidence for screening for hypertension in adults and found that the benefits outweigh the harms of screening (1). The benefits of screening for hypertension are well established; therefore, the USPSTF decided to do a targeted literature search. This literature search focused on finding evidence of the direct benefits of screening, the harms of screening, and the harms of treatment of screen-detected or mild-to-moderate severity hypertension (3). The USPSTF found no new substantial evidence about the benefits and harms of screening for high blood pressure that would lead them to change the previous recommendation and therefore reaffirms its recommendation that clinicians screen for high blood pressure in adults age 18 years or older. The 2003 recommendation statement, the 2003 evidence report, and the current summary of the updated literature search can be found at http://www.preventiveservices.ahrq.gov.
Recommendations of Other Groups
The JNC 7 calls for routine blood pressure measurement at least once every 2 years for adults with systolic blood pressure less than 120 mm Hg and diastolic blood pressure less than 80 mm Hg, and every year for those with systolic blood pressure 120 to 39 mm Hg and diastolic blood pressure 80 to 89 mm Hg (2).
The American Heart Association issued similar recommendations for adults beginning at age 20 years (4).
The American Academy of Family Physicians strongly recommends that family physicians screen adults age 18 years or older for high blood pressure (5).
The American College of Obstetricians and Gynecologists recommends measuring blood pressure as part of the periodic assessment in women age 13 years or older (6).
Appendix: U.S. Preventive Services Task Force
Members of the U.S. Preventive Services Task Force† are Ned Calonge, MD, MPH, Chair (Colorado Department of Public Health and Environment, Denver, Colorado); Diana B. Petitti, MD, MPH, Vice Chair (Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Sierra Madre, California); Thomas G. DeWitt, MD (Children's Hospital Medical Center, Cincinnati, Ohio); Leon Gordis, MD, MPH, DrPH (Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland); Kimberly D. Gregory, MD, MPH (Cedars-Sinai Medical Center, Los Angeles, California); Russell Harris, MD, MPH (University of North Carolina School of Medicine, Chapel Hill, North Carolina); George Isham, MD, MS (HealthPartners, Minneapolis, Minnesota): Michael L. LeFevre, MD, MSPH (University of Missouri School of Medicine, Columbia, Missouri); Carol Loveland-Cherry, PhD, RN (University of Michigan School of Nursing, Ann Arbor, Michigan); Lucy N. Marion, PhD, RN (Medical College of Georgia, Augusta, Georgia); Virginia A. Moyer, MD, MPH (University of Texas Health Science Center, Houston, Texas); Judith K. Ockene, PhD (University of Massachusetts Medical School, Worcester, Massachusetts); George F. Sawaya, MD (University of California, San Francisco, San Francisco, California); Albert L. Siu, MD, MSPH (Mount Sinai Medical Center, New York, New York); Steven M. Teutsch, MD, MPH (Merck & Co., West Point, Pennsylvania); and Barbara P. Yawn, MD, MSc (Olmsted Research Center, Rochester, Minnesota).
†Members of the Task Force at the time this recommendation was finalized. For a list of current Task Force members, go to http://www.ahrq.gov/clinic/uspstfab.htm.
Article and Author Information
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Disclaimer: Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
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Financial Support: The USPSTF is an independent, voluntary body. The U.S. Congress mandates that the Agency for Healthcare Research and Quality support the operations of the USPSTF.
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Potential Financial Conflicts of Interest: None disclosed.
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Requests for Single Reprints: Reprints are available from the USPSTF Web site (http://www.preventiveservices.ahrq.gov).
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↵* For a list of members of the U.S. Preventive Services Task Force, see the Appendix.
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