USPSTF Reaffirms Recommendation for Hypertension Screening in Adults

The US Preventive Services Task Force (USPSTF) has published a reaffirmation recommendation statement on the screening of hypertension in adults. The statement, which is a reaffirmation of the organization’s 2015 recommendation, was published in a recent edition of JAMA.

The new statement is based on a systematic review of newly available literature. The USPSTF commissioned the review to evaluate studies that reported the benefits as well as harms associated with hypertension screening in adult patients. The organization also examined the accuracy of in-office blood pressure measurement for initial hypertension screening as well as the accuracy of different confirmatory blood pressure measurement strategies.

In 2015, the USPSTF recommended that adults who are at least 18 years old without known hypertension should be screened for the high blood pressure disorder. The newest literature review reaffirms this recommendation, according to the USPSTF paper.

To implement the recommendation, the USPSTF recommended measuring blood pressure using an office blood pressure measurement for initial screening. Confirmation should be performed outside of the clinical setting before making a final diagnosis. Ambulatory blood pressure monitoring using a programmed portable device to automatically take blood pressure measurements is a recommended method for confirming diagnosis. Another includes the use of home blood pressure monitoring with an automated device.

The USPSTF noted that there is limited evidence regarding optimal screening intervals but recommended screening for hypertension each year in adults who are at least 40 years old as well as in adults who have risk factors for hypertension. Clinicians could consider screening less frequently, such as every 3 to 5 years, in adults between 18 and 39 years of age who do not have hypertension risk factors and have a prior normal blood pressure reading.

In the new statement, the USPSTF also recommended clinicians perform risk assessment for cardiovascular disease in patients with nontraditional risk factors. The organization stated that clinicians could also consider screening for atrial fibrillation with electrocardiography in select patients.

Behavioral counseling promoting a healthy diet and physical activity is another recommended approach that the USPSTF said could reduce the risk of cardiovascular disease in patients with hypertension. Additionally, statins are recommended for the primary prevention of cardiovascular disease in adults.

The authors of the USPSTF statement concluded “the current reaffirmation clarifies that initial screening should be performed with [office blood pressure measurement], updates language to be more consistent with current evidence, and clarifies implementation strategies.”

Reference

Krist AH, Davidson KW, Mangione CM, et al. Screening for hypertension in adults: US Preventive Services Task Force reaffirmation recommendation statement. JAMA. 2021;325(16):1650-1656. doi:10.1001/jama.2021.4987