June 23, 2020
The US Preventive Services Task Force today posted a draft recommendation statement reaffirming that clinicians should screen all adults for high blood pressure to improve the health of their patients. This is a Grade A recommendation.
"Our review reaffirms the current Grade A recommendation for hypertension screening, and acknowledge that clinicians should be screening all adults 18 years or older for office blood-measured pressure years, and those found to have a raised level [higher] than this should be confirmed in an out-of-office measurement — either at home or with an ambulatory device," task force member John Wong, MD, Tufts University School of Medicine, Boston, Massachusetts, told Medscape Medical News.
"Detection of hypertension in this way and its treatment can significantly reduce long-term mortality and morbidity. Patients aged over 40 or anyone with other cardiovascular risk factors should have an annual blood pressure check," Wong said.
Screening less frequently (every 3 to 5 years) is appropriate for adults ages 18 to 39 years not at increased risk for hypertension and with a prior normal blood pressure reading, the statement says.
Explaining the reaffirmation process, Wong noted that USPSTF revisits recommendations made in the past to update the evidence base and explore new studies that might change the recommendations.
"We looked at this in 2015 when there was a grade A recommendation for hypertension screening," he said. "Our current recommendation reaffirms this."
Using a reaffirmation deliberation process, the USPSTF concludes with high certainty that the net benefit of screening for hypertension in adults is substantial, the statement says.
The current recommendation is very similar to that of 2015, Wong said. "There is just one small change in that we are making a distinction between high blood pressure as a single measurement and hypertension, which is a sustained increase in blood pressure measured both in and out of the doctor's office."
"We revisit the recommendations every few years because hypertension is a very common medical problem — estimated to affect almost half the US population — and is a major risk factor for future health complications, which has significant implications for population health," Wong commented.
"It is therefore important to review new evidence and reaffirm the recommendations regularly. It is also an opportunity to remind physicians and patients if they are not getting blood pressure checked at the clinician's office they really need to go ahead and do this."
Generally, the threshold that has been used to define hypertension by various organizations ranges from 130/80 mm Hg or greater to 140/90 mm Hg or greater. For the purposes of this recommendation, the USPSTF reviewed evidence from studies that included any threshold used to define hypertension.
There are different types of hypertension, including "sustained" hypertension (blood pressure measurements that are high when obtained both in a clinical office setting and outside the office), "white coat" hypertension (blood pressure measurements that are high only when obtained in a clinical office setting but normal when obtained outside the office), and "masked" hypertension (blood pressure measurements that are high only when obtained outside the office but normal when obtained in clinical office settings), the statement notes.
Cardiovascular disease risk is highest among persons with sustained hypertension, followed by those with masked hypertension, and then white coat hypertension. The prevalence of white coat and masked hypertension in the United States is unknown, but estimates based on data from international cohorts are 8% and 14%, respectively, it states.
Although the association of masked hypertension and white coat hypertension with increased cardiovascular risk has been well documented, it is unclear whether treatment of either of these types of hypertension improves health outcomes. The USPSTF considers this a critical evidence gap, the statement says.
The Task Force's draft recommendation statement and draft evidence review have been posted for public comment on the Task Force website at www.uspreventiveservicestaskforce.org. Comments can be submitted until July 20 at www.uspreventiveservicestaskforce.org/tfcomment.htm.