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Task Force Issues Recommendation Statement on Screening for Hypertension

Experts find benefit in screening all adults without known hypertension

The U.S. Preventive Services Task Force has issued a draft recommendation statement and an evidence summary on screening for hypertension in adults. After reviewing the evidence, the task force found that screening individuals 18 years of age and older for hypertension has a beneficial effect on important health outcomes.

The task force is providing an opportunity for public comment on its draft recommendation statement until January 26, 2015.

“Evidence continues to show a substantial benefit in screening adults for high blood pressure,” said task force chair Michael L. LeFevre, MD, MSPH. “Accurate screening and appropriate treatment can help prevent strokes, heart attacks, and other health conditions.”

Some patients who screen positive for hypertension in a medical setting, however, may not have sustained hypertension. Blood pressure can be temporarily elevated because of stress, physical activity, the use of caffeine or nicotine, or other factors. A patient may also experience “white coat” hypertension, in which blood pressure is only temporarily elevated in a medical setting or in the presence of medical personnel.

As a result, the task force recommends that clinicians use ambulatory blood pressure monitoring to confirm the diagnosis of hypertension, except for patients who need to begin treatment immediately, such as those with very high blood pressure at screening or a related health condition. Ambulatory blood pressure monitoring involves wearing a cuff attached to a small, portable machine that records blood pressure repeatedly over 24 to 48 hours.

“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 task force member Mark Ebell, MD, MS. “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.”

After an initial screening, adults 40 years of age and older, and those who are at increased risk for hypertension, should be screened again each year, the task force says. Adults 18 to 39 years old with normal blood pressure who do not have other risk factors should be screened again every 3 to 5 years.

People at increased 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. People are also more likely to develop hypertension as they get older.

Sources: USPSTF; December 23, 2014; and Draft Recommendation; December 23, 2014.

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