USPSTF Finds Screening Adults for Hypertension Still Beneficial

Task Force Recommends Ambulatory Blood Pressure Monitoring to Confirm Diagnosis

January 07, 2015 01:46 pm News Staff

High blood pressure affected almost 30 percent of the U.S. population from 2011-2012, making it the condition most commonly diagnosed during outpatient office visits, according to the U.S. Preventive Services Task Force (USPSTF).

[Senior man checking blood pressure]

Hypertension is a known risk factor for heart failure, heart attack, stroke and chronic kidney disease. And in 2010, it was the primary or contributing cause of death for more than 362,000 Americans.

To help guide physicians in their efforts to quell the growing number of patients with hypertension, the USPSTF posted a draft recommendation statement(www.uspreventiveservicestaskforce.org) on Dec. 22 that reaffirms the benefit of screening for high blood pressure in adults 18 and older. This recommendation updates a 2007 recommendation statement and is a grade A(www.uspreventiveservicestaskforce.org) recommendation.

"Evidence continues to show a substantial benefit in screening adults for high blood pressure," said family physician and USPSTF Chair Michael LeFevre, M.D., M.S.P.H., of Columbia, Mo., in a USPSTF Bulletin.(www.uspreventiveservicestaskforce.org) "Accurate screening and appropriate treatment can help prevent strokes, heart attacks and other health conditions."

The USPSTF also suggests physicians use ambulatory blood pressure monitoring to confirm elevated blood pressure before the diagnosis of hypertension is made, except in cases where immediate initiation of therapy is necessary.

Story highlights
  • The U.S. Preventive Services Task Force (USPSTF) posted a draft recommendation statement Dec. 22 that updates its 2007 recommendation and reaffirms the benefit of screening for high blood pressure in adults 18 and older.
  • For this recommendation, the USPSTF examined the diagnostic accuracy of office blood pressure measurement, ambulatory blood pressure monitoring and home blood pressure monitoring.
  • The USPSTF also assessed the accuracy of these measurements and methods in confirming the diagnosis of hypertension and reviewed data on optimal screening intervals for diagnosis.

"Evidence shows that ambulatory blood pressure monitoring more accurately predicts the risk for strokes, heart attacks and other health outcomes than blood pressure screening done in a medical setting," said family physician and USPSTF member Mark Ebell, M.D., M.S., in the bulletin. "Confirming a diagnosis of high blood pressure with ambulatory blood pressure monitoring is an important step to ensure that we are carefully and accurately diagnosing this condition."

Update to 2007 Recommendation

In 2007, the USPSTF reaffirmed its 2003 recommendation to screen for hypertension in adults. The Academy mirrored the UPSTSF's guidance in its own 2007 recommendation for adult hypertension screening.

Previous USPSTF evidence reviews found good-quality evidence that screening for hypertension conferred few major harms and provided substantial benefits. However, the previous evidence reviews did not address the diagnostic accuracy of different blood pressure measurement protocols or identify a reference standard for measurement confirmation, this latest draft recommendation noted.

Draft Recommendation Overview

For the current recommendation, the USPSTF examined the diagnostic accuracy of office blood pressure measurement, ambulatory blood pressure monitoring and home blood pressure monitoring. Task force members also assessed the accuracy of these blood pressure measurements and methods in confirming the diagnosis of hypertension and reviewed data on optimal screening intervals for diagnosis.

The recommendation stated that after an initial screening, people ages 40 and older and those who are at increased risk for high blood pressure, should be screened again each year. Adults younger than 40 who have normal blood pressure and no other risk factors should be screened again every three to five years.

People at increased risk for developing high blood pressure include those with high-normal blood pressure (130–139/85–89 mm Hg), African Americans, and those who are obese or overweight, said the task force. The likelihood of developing high blood pressure also increases with age.

The USPSTF is providing an opportunity for public comment(www.uspreventiveservicestaskforce.org) on this draft recommendation statement until Jan. 26.

The AAFP is reviewing the draft recommendation and will update its own 2007 recommendation after the USPSTF publishes its final recommendation later this year.

Related AAFP News Coverage
Evidence -based Hypertension Guideline Garners AAFP Endorsement
(9/10/2014)

2014 Hypertension Guideline Stands to Simplify Treatment, Says Expert
AAFP to Begin Rigorous Process of Reviewing for Possible Endorsement

(12/18/2013)

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