USPSTF Reaffirms Advice to Screen Adults for Hypertension

Megan Brooks

April 27, 2021

The US Preventive Services Task Force (USPSTF) continues to recommend that clinicians screen all adults aged 18 years and older for high blood pressure and that they confirm a diagnosis of hypertension with blood pressure measurements taken outside the office before starting treatment.

This grade A recommendation is consistent with the 2015 recommendation from the task force.

Hypertension affects approximately 45% of adults in the United States and is a major contributing risk factor for heart failure, myocardial infarction, stroke, and chronic kidney disease.

Using a reaffirmation deliberation process, the USPSTF concluded with high certainty that there was "substantial net benefit" from screening adults for hypertension in clinical office settings.

The reaffirmation recommendation clarifies that initial screening should be performed with office-based blood pressure measurement.

The task force found "convincing" evidence that screening for and treatment of hypertension detected in clinical office settings substantially reduces cardiovascular events and have few major harms.

To confirm a diagnosis of hypertension outside the office before starting treatment, ambulatory blood pressure monitoring or home blood pressure monitoring is recommended. Blood pressure measurements should be taken at the brachial artery with a validated and accurate device in a seated position after 5 minutes of rest.

Although evidence regarding optimal screening intervals is limited, the task force says "reasonable" options include screening for hypertension every year for adults aged 40 years or older and for adults who are at increased risk for hypertension, such as Black persons, persons with high-normal blood pressure, or those who are overweight or obese.

Screening less frequently (every 3 to 5 years) is appropriate for adults aged 18 to 39 years who are not at increased risk for hypertension and who have received a prior blood pressure reading that was in the normal range, says the task force, led by Alex Krist, MD, MPH, Virginia Commonwealth University, Richmond, Virginia.

The recommendation and supporting evidence report were published online April 27 in JAMA.

"Screening Is Just the First Step"

In a JAMA editorial, Marwah Abdalla, MD, MPH, Columbia University Irving Medical Center, New York City, and co-authors say the COVID-19 pandemic has demonstrated that "rapid and significant innovation in science, health care, and society is possible. Implementing the latest USPSTF recommendations will require widespread changes to how the health care system and other entities screen for hypertension.

"Yet screening is just the first step in a long road to controlling hypertension. Medicine and society need to implement a variety of interventions proven to be effective in controlling blood pressure at scale," the editorialists say.

"Additionally, these efforts need to consider how to achieve success for all people. This will require working to address the roots of structural racism and reduce the racial disparities that increase hypertension-related morbidity and mortality for vulnerable populations," they add.

"These changes will take innovation in how care delivery is provided at both the individual and population levels ― lessons the health care system and society learned are achievable through the response to the COVID-19 pandemic," Abdalla and colleagues conclude.

The USPSTF and Abdalla have reported no relevant financial relationships. One editorialist reported receiving personal fees from Livongo and Cerner and grants from Bristol-Myers Squibb.

JAMA. Published online April 27, 2021. Recommendations; Review; Editorial

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