Screening for High Blood Pressure in Adults: U.S. Preventive Services Task Force Recommendation Statement

Who developed these recommendations? The U.S. Preventive Services Task Force (USPSTF) developed these recom-mendations. The USPSTF is a group of health experts that reviews published research and makes recommendations about preventive health care. What is the problem and what is known about it so far? High blood pressure (hypertension) is a common chronic condition in adults. High blood pressure strains the heart and harms blood vessels. It increases the risk for such complications as heart problems, stroke, kidney problems, and eye problems. Diet, exercise, and drugs can reduce blood pressure and decrease the chances of these complications. People with high blood pressure usually do not have symptoms, so they often do not know that they have it until someone measures their blood pressure. Screening for high blood pressure involves routinely measuring blood pressure even in people who feel well. Health care organizations have recommended screening for high blood pressure because it is common, measurement is easy and safe, symptoms usually do not appear until complications develop, and good treatments are available. The benefits of screening include prevention of complications. The harms of screening include prescription of drugs that may cause adverse effects in people with early high blood pressure. The USPSTF wanted to review research published since its last recommendation about blood pressure screening in 2007 to update its recommendation. The USPSTF was particularly interested in 2 issues. First, when should screening be repeated after an initial screening result is normal? Second, which methods are best for confirming high blood pressure found on initial screening? In addition to measuring blood pressure in a medical setting (office monitoring), ambulatory or home blood pressure monitoring may be used to confirm hypertension. Ambulatory blood pressure monitoring devices are small, portable machines that record blood pressure at regular intervals over 12 to 24 hours while patients go about their normal activities. Home blood pressure monitoring uses automated devices that let patients record blood pressure at home. Not all home monitors have undergone technical validation according to recommended protocols. How did the USPSTF develop these recommendations? The USPSTF reviewed the research published since its 2007 recommendation about the accuracy of different methods for confirming hypertension after an initial positive screening result and about the best frequency for screening. What did the authors find? The authors found clear evidence that the benefits of screening for hypertension outweigh the risks. Ambulatory blood pressure monitoring is the best method for diagnosing hypertension, and home blood pressure monitoring may be acceptable if ambulatory monitoring is not possible. Good information about the best frequency for screening is not available. What does the USPSTF recommend that patients and doctors do? The USPSTF recommends screening for high blood pressure in adults aged 18 years or older and taking measurements outside of medical settings to confirm high blood pressure before starting treatment. What are the cautions related to these recommendations? A recent study may result in changes to the definition of high blood pressure.