USPSTF reaffirms endorsement of hypertension screening in adults
Click Here to Manage Email Alerts
After a systematic review, the U.S. Preventive Services Task Force reaffirmed its endorsement of screening for hypertension with office BP measurement in adults aged 18 years or older.
According to the statement published in JAMA, the diagnosis of hypertension should later be confirmed using out-of-office methods such as ambulatory or home BP monitoring.
“In 2015, the USPSTF reviewed the evidence for screening for hypertension in adults and issued an A recommendation,” Alex H. Krist, MD, MPH, associate professor of family medicine and population health, co-director of the Virginia Ambulatory Care Outcomes Research Network and director of community engaged research at the Center for Clinical and Translational Research at Virginia Commonwealth University, and colleagues wrote. “The USPSTF has decided to use a reaffirmation deliberation process to update this A recommendation.”
The USPSTF conducted a systematic review of the pros and cons of screening for hypertension in adults, the accuracy of office BP measurement for initial screening, and the accuracy of various confirmatory BP measurement methods.
After its evidence review, the USPSTF recommended hypertension screening for all adults aged 18 years or older, which is consistent with its 2015 recommendation.
Overall, the USPSTF determined that the harms of screening for hypertension are minor.
The USPSTF recommends clinicians evaluate BP with an office BP measurement.
To confirm a hypertension diagnosis, the statement recommends taking BP measurements outside of the clinical setting, via ambulatory or home BP monitoring, before initiating treatment.
For measurements outside of the clinical setting, BP should be taken at the brachial artery in the upper arm with a validated device while in the seated position after 5 minutes of rest, according to the statement.
The task force recommended early BP screening in adults aged 40 years or older and in those at increased risk for hypertension, such as Black individuals, those with high-normal BP or individuals with overweight or obesity. The task force deemed screening every 3 to 5 years was appropriate for adults aged 18 to 39 years who are not at increased risk for hypertension and who have a prior normal BP reading.
Areas for future research
The USPSTF identified the following as areas of interest for future research:
- The pros and cons of early detection and treatment of masked hypertension and white-coat hypertension.
- Does early detection of masked hypertension and white-coat hypertension improve outcomes.
- Does treating masked hypertension improve CV outcomes?
- Does treating white-coat hypertension cause harms?
- The prevalence of masked hypertension and white-coat hypertension in the U.S.
- How frequently do adults transition between the different types of hypertension, and how long is the length of time it takes to transition?
- Identification of feasible methods for early detection of masked hypertension.
The task force wrote that inclusion of diverse and underrepresented persons in all of the above research areas is needed to determine optimal screening for all types of hypertension.
USPSTF vs. ACC/AHA guidelines
“In contrast with the USPSTF recommendations, both the U.S. and European professional society guidelines support more intensive screening and confirmation strategies, especially with regards to detecting patients with the higher-risk masked hypertension phenotype,” Yuichiro Yano, MD, PhD, adjunct associate professor in the department of family medicine and community health at Duke University, and Donald M. Lloyd-Jones, MD, ScM, chair of the department of preventive medicine at Northwestern University Feinberg School of Medicine, wrote in a related editorial. “The 2017 American College of Cardiology/American Heart Association/multispecialty guidelines on BP management define hypertension as BP levels of 130 mm Hg or higher systolic or 80 mm Hg or higher diastolic. These U.S. guidelines recommend ambulatory or home BP monitoring as reasonable services to offer after a 3-month trial of lifestyle modification for untreated patients with office BP of 130/80 mm Hg or higher and less than 160/100 mm Hg to detect white-coat hypertension and for untreated patients with office BP 120 to 129 mm Hg systolic or 75 to 79 mm Hg diastolic to detect masked hypertension.”
Reference:
Yano Y, et al. JAMA. 2021;doi:10.1001/jamacardio.2021.1122.
Perspective
Back to Top
Prevention is something that requires personal responsibility and discipline as well as knowledge. The USPSTF provides the knowledge needed to undertake a prevention program. The biggest takeaways outlined are:
No. 1, all adults 18 and over should be screened for hypertension using office BP measurement and subsequently checked at home.
No. 2, people 40 years and older at high risk (eg, family history, Black race) should be screened annually.
No. 3, the USPSTF recommends obtaining BP measurements outside of the clinical setting for diagnostic confirmation before starting treatment and ideally, although not practical, a 24-hour ambulatory BP monitor.
No. 4, patients should be instructed on how to measure BP at home and the approach is that used in recent clinical trials supported by national and international hypertension guidelines.
I fully endorse this recommendation, especially with the increasing incidence of obesity and relative lack of appreciation of elevated BP and its consequences by many people when not treated.
The document covers screening well and there are no substantive questions that remain but to the “worried well.” It is fine to screen for hypertension but not overdo it by checking daily or multiple times a day when there is no history or risk factors for hypertension.
Collapse
Click Here to Manage Email Alerts