Putting Prevention into Practice
An Evidence-Based Approach
Screening for High Blood Pressure in Adults
Am Fam Physician. 2016 Mar 15;93(6):511-512.
Related U.S. Preventive Services Task Force Recommendation Statement: Screening for High Blood Pressure in Adults: Recommendation Statement.
Author disclosure: No relevant financial affiliations.
A 55-year-old black man presents for a blood pressure evaluation. He is trying to be more physically active and health conscious but has not seen a physician for five years. He takes no medications, has no concerns, and his physical examination findings are unremarkable. According to the blood pressure monitoring machine at his gym, his blood pressure has ranged from 150 to 160 over 90 to 100 mm Hg over several weeks. Your clinic's technician, using a manual sphygmomanometer on the left arm, measures his blood pressure as 167/95 mm Hg.
Case Study Questions
Based on the U.S. Preventive Services Task Force (USPSTF) recommendation statement, which one of the following is the best way to diagnose hypertension in this patient?
A. You can diagnose hypertension based on a single manual measurement done upon entry to the office.
B. You can diagnose hypertension only if repeat office blood pressure measurements are elevated after a three-month period of lifestyle changes.
C. You recommend that the patient wear an ambulatory blood pressure monitoring (ABPM) device for a 24-hour period and return for a follow-up evaluation.
D. You tell the patient that he does not have high blood pressure and should return in one year for rescreening.
If the patient is eventually diagnosed with high blood pressure, which of the following classes of medications are appropriate choices for initial treatment?
A. Angiotensin receptor blocker.
B. Calcium channel blocker.
C. Beta blocker.
D. Thiazide diuretic.
The patient asks if his 19-year-old son should be screened for high blood pressure. Based on the USPSTF's findings, which
U.S. Preventive Services Task Force. Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2015;163(10):778–786.
Piper MA, Evans CV, Burda BU, Margolis KL, O'Connor E, Whitlock EP. Diagnostic and predictive accuracy of blood pressure screening methods with consideration of rescreening intervals: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2015;162(3):192–204.
James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8) [published correction appears in JAMA. 2014;311(17):1809]. JAMA. 2014;311(5):507–520.
This PPIP quiz is based on the recommendations of the USPSTF. More information is available in the USPSTF Recommendation Statement and the supporting evidence on the USPSTF website (http://www.uspreventiveservicestaskforce.org). The practice recommendations in this activity are available at http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/high-blood-pressure-in-adults-screening.
This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.
A collection of Putting Prevention into Practice published in AFP is available at http://www.aafp.org/afp/ppip.
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