Putting Prevention into Practice

An Evidence-Based Approach

Screening for Hypertension in Adults

 

Am Fam Physician. 2021 Aug ;104(2):193-194.

Author disclosure: No relevant financial affiliations.

Related letter: Automated Office Blood Pressure for Diagnosing Hypertension

Case Study

A 23-year-old patient, M.C., comes to your office for a wellness visit with no concerns. On reviewing the patient's medical record, you note that M.C. has a history of polycystic ovary syndrome, blood pressure of 110/70 mm Hg from a visit one year ago, and a body mass index of 28.2 kg per m2.

Case Study Questions

1. According to the U.S. Preventive Services Task Force (USPSTF) recommendation statement, which one of the following steps regarding screening for hypertension is appropriate for M.C.?

  • A. Screen M.C. for hypertension today because of the patient's history of polycystic ovary syndrome.

  • B. Defer screening M.C. for hypertension for another two to four years because the patient's blood pressure was not elevated one year ago.

  • C. Screen M.C. for hypertension today because the patient's body mass index is in the overweight range.

  • D. Defer screening M.C. for hypertension until 40 years of age.

  • E. Ask M.C. to begin monitoring their blood pressure at home.

2. M.C. had a blood pressure of 143/81 mm Hg upon arrival in the examination room. M.C. reports no headache, blurry vision, chest pain, shortness of breath, or blood in urine. According to the USPSTF recommendation statement, which one of the following steps is correct?

  • A. Prescribe the patient an angiotensin-converting enzyme inhibitor, such as lisinopril, and schedule a follow-up visit in three months.

  • B. Ask M.C. to monitor their blood pressure at home and schedule a follow-up visit to discuss the results.

  • C. Prescribe the patient a calcium channel blocker, such as amlodipine (Norvasc), and schedule a follow-up visit in three months.

  • D. Wait until the next follow-up visit in six to 12 months to confirm the diagnosis of hypertension.

  • E. Repeat the blood pressure measurement today and prescribe an antihypertensive medication if the blood pressure remains elevated.

3. Which of the following blood pressure monitoring methods can you use to confirm

Author disclosure: No relevant financial affiliations.

References

1. Guirguis-Blake JM, Evans CV, Webber EM, et al. Screening for hypertension in adults: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2021;325(16):1657–1669.

2. Krist AH, Davidson KW, Mangione CM. Screening for hypertension in adults: US Preventive Services Task Force reaffirmation recommendation statement. JAMA. 2021;325(16):1650–1656.

3. Kronish IM, Hughes C, Quispe K, et al. Implementing ambulatory blood pressure monitoring in primary care practice. FPM. 2020;27(3):19–25. Accessed June 13, 2021. https://www.aafp.org/fpm/2020/0500/p19.html

This PPIP quiz is based on the recommendations of the USPSTF. More information is available in the USPSTF Recommendation Statement and supporting documents on the USPSTF website (https://www.uspreventiveservicestaskforce.org). The practice recommendations in this activity are available at https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/hypertension-in-adults-screening.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

A collection of Putting Prevention into Practice published in AFP is available at https://www.aafp.org/afp/ppip.

 

 

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