The aging of the U.S. population brings with it multiple effects on the nation's health, not least of which is a steady rise in the prevalence of hypertension. As front-line clinicians, family physicians recognize that with that increase comes a significant jump in patients' risks for heart attacks, strokes, and kidney and heart failure.
To help guide physicians in their efforts to minimize those risks through early detection and management of elevated blood pressure, the U.S. Preventive Services Task Force (USPSTF) just released its final recommendation statement(www.uspreventiveservicestaskforce.org) on screening for hypertension in adults. After reviewing the evidence,(www.uspreventiveservicestaskforce.org) the USPSTF found that screening patients ages 18 and older for high blood pressure has a profound and positive impact on important health outcomes -- an "A" recommendation.(www.uspreventiveservicestaskforce.org)
The AAFP has released a recommendation on hypertension screening in adults that mirrors that of the task force.
Clear Evidence of Benefit
"We have clear evidence that blood pressure screening has a substantial benefit for adults," said family physician and USPSTF member Mark Ebell, M.D., M.S., in an Oct. 13 USPSTF Bulletin.(www.uspreventiveservicestaskforce.org) "Screening patients, and following through with appropriate treatments, can help prevent strokes, heart attacks and other health conditions."
- On Oct. 13, the U.S. Preventive Services Task Force released its final recommendation on screening adults for hypertension, finding that screening patients 18 and older is beneficial.
- The task force recommended physicians use measurements outside of the clinical setting to confirm the diagnosis of hypertension unless an initial in-clinic screening indicates a patient should begin treatment immediately.
- The USPSTF determined ambulatory blood pressure monitoring was the best method to confirm a diagnosis outside of the clinical setting.
However, some patients who screen positive for hypertension in the office setting might not experience sustained high blood pressure, because blood pressure may be temporarily elevated due to stress (including that provoked by the medical setting, known as "white-coat hypertension"), physical activity, caffeine or nicotine use, or other factors.
Therefore, the task force recommended physicians use measurements outside of the clinical setting to confirm the diagnosis of hypertension unless an initial in-clinic screening indicates a patient should begin treatment immediately, such as when a very high blood pressure reading or related health condition is present.
This final recommendation updates the USPSTF's 2007 recommendation, which also found good-quality evidence that screening for hypertension conferred few major harms and provided substantial benefits but did not address the diagnostic accuracy of different blood pressure measurement protocols or identify a reference standard for measurement confirmation.
Final Recommendation Breakdown
The USPSTF determined that the evidence reviewed pointed to ambulatory blood pressure monitoring as the best method to confirm a suspected hypertension diagnosis. Monitoring using this device, which consists of a cuff attached to a small, portable machine that records blood pressure repeatedly during a period of 12 to 48 hours, more accurately predicted the risk of strokes, heart attacks and other health outcomes than blood pressure screening in the medical setting alone, said task force members. Many such devices are available at major retailers.
If patients cannot easily access ambulatory blood pressure monitoring equipment, family physicians instead can recommend they consider monitoring their blood pressure at home using a simple inflatable cuff, strap or other device.
As for the best interval for in-office hypertension screening, the USPSTF said that after an initial screening, patients 40 and older and those at increased risk for high blood pressure should be screened annually. Patients ages 18-39 who have normal blood pressure and no other risk factors may be screened every three to five years.
In its recommendation statement, the task force reaffirmed that patients at the highest risk for developing hypertension include those with high-normal blood pressure (130-139/85-89 mm Hg), African Americans and those who are obese or overweight. As previously noted, patients also are more likely to develop hypertension as they age.
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