1. From a systematic review, the USPSTF recommends ambulatory blood pressure monitoring (ABPM) as the preferred method to confirm a hypertension diagnosis.
2. The USPSTF also recommends that adults at increased risk for high blood pressure should be screened annually.
Evidence Rating Level: 1 (Excellent)
Study Rundown: High blood pressure affects millions of Americans annually, and it is a major risk factor for cardiovascular, cerebrovascular, and chronic kidney diseases. In a 2007 recommendation statement, the U.S. Preventive Services Task Force (USPSTF) endorsed screening for high blood pressure in all adults over the age of 18. The current recommendation reiterates the USPSTF’s 2007 recommendations, with the benefits strongly outweighing the risks of high blood pressure screening. The current recommendations also state that blood pressures measured in the office should be confirmed with ambulatory blood pressure monitoring (ABPM), since many office measurements may be affected by “white coat hypertension.” Based on the USPSTF’s literature review, ABPM also has a higher positive predictive value for many comorbid conditions. If ABPM is not available, home blood pressure screening is sufficient to confirm an elevated office measurement. The USPSTF also recommends annual screening for adults aged 40 or older and adults at increased risk for high blood pressure. Adults aged 18-39, with normal blood pressure and no risk factors, can be screened every 3-5 years. The primary limitations of this recommendation are the potential harms of screening, which included mild harms such as sleep disturbance, discomfort and restrictions in daily activities. Overall, the USPSTF found sufficient evidence to recommend blood pressure screening in adults.
In-Depth [systematic review]: The USPSTF conducted a systematic review to update its 2007 recommendation on screening for high blood pressure in adults aged 18 or older. The literature review found that isolated elevated clinical blood pressure failed to replicate during ABPM approaches for 5% to 65% of study participants. The review also found that ABPM has a better positive predictive value for both stroke and cardiovascular disease. Four studies showed that each 10 mm Hg increase in ABP was significantly associated with increased risk for stroke, and six studies found the same was true for CVD (HRs range from 1.11-1.42). Although no clinical trials examined the effect of screening interval length on morbidity and mortality, observational studies suggest a greater than 20% risk of hypertension at 3-5 years in patients with one or more risk factors. This recommendation statement is grade A based on the high quality of its supporting evidence.
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