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Screening for High Blood Pressure

USPSTF updates guidelines

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The US Preventive Services Task Force (USPSTF) has updated a recommendation statement that endorses screening for high blood pressure in adults aged ≥18 years without known hypertension. This recommendation statement updates the 2007 reaffirmation recommendation and suggests:

• Screening for high pressure using office blood pressure measurement.

• Obtaining measurements outside of the clinical setting should be obtained for diagnostic confirmation before starting treatment. Either ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) can be used to confirm a diagnosis of hypertension after initial screening.

• Adults aged ≥40 years and persons at increased risk for high blood pressure should be screened annually. Those who are at increased risk include those with high-normal blood pressure (130–139/85–89 mm Hg), individuals who are overweight or obese, and African Americans.

• Adults aged 18 to 39 years with normal blood pressure (<130/85 mm Hg) who do not have other risk factors should be rescreened every 3 to 5 years.

Citation: Siu AL, Bibbins-Domingo K, Grossman D, et al. Screening for high blood pressure in adults: US preventive services task force recommendation statement. [Published online ahead of print October 13, 2015]. Ann Intern Med. doi: 10.7326/M15-2223.

Commentary: Hypertension is one of the most common risk factors that we treat in the office, increasing in prevalence from 7% in persons aged 18 to 39 years to 65% in those above 60 years of age. The main impact of this new guideline will be in its recommendation that before embarking on treatment, the diagnosis of hypertension should be confirmed by either ABPM or HBPM. This is a significant change from JNC 8.1 The reason for this is twofold. ABPM and HBPM are better predictors of cardiac events than in-office blood pressures and between 15% and 30% of individuals with elevated in-office blood pressures have normal blood pressures outside of the office.2 When HBPM is recommended, it should be performed twice a day, preferably first thing in the morning and then before bedtime, in order to reflect accurately a person’s ambulatory readings. The frequency of such testing is up to the discretion of the clinician.3 —Neil Skolnik, MD

1. 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). JAMA. 2014;311(5):507-520. doi:10.1001/jama.2013.284427.

2. Piper MA, Evans CV, Burda BU, et al. Screening for high blood pressure in adults: A systematic evidence review for the U.S. Preventive Services Task Force. Evidence synthesis no. 121. AHRQ publication no. 13-05194-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2014.

3. Pickering TG, Miller NH, Ogedegbe G, Krakoff LR, Artinian NT, Goff D. Call to action on use and reimbursement for home blood pressure monitoring: A joint scientific statement from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association. Hypertension. 2008;52:10-29.

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