The U.S. Preventive Services Task Force (USPSTF) recently updated recommendations for screening of high blood pressure. According to the Task Force, screening is recommended in adults 18 years and older and measurements should be taken “outside of the clinical setting for diagnostic confirmation before starting treatment.”

According to the USPSTF report, high blood pressure, which affects about 30 percent of adults, is the most commonly diagnosed condition at outpatient office visits. While the Task Force has recommended screening in adults age 18 and older for many years, this is the first time it has evaluated diagnostic accuracy of office blood pressure management, ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM). The report concluded that because of issues including “measurement errors, the limited number of measurements that can be made conveniently, and the cofounding risk for isolated clinic hypertension,” ABPM is the “best method” for the diagnosis of hypertension and should be the “reference standard for confirming the diagnosis of hypertension.” Additionally, HBPM may be helpful for confirming hypertension.

“Available evidence supports the importance of ABPM and home blood pressure measurements for the accurate diagnosis of hypertension,” said Pamela Bowe Morris, MD, FACC, chair of the ACC’s Prevention of Cardiovascular Disease Section Leadership Council. “This final guidance is on point and consistent with current current professional society guidelines.”

As for screening interval, the Task Force recommends annual screening for adults aged 40 or over and patients with an increased risk for hypertension. “Persons at increased risk include those who have high-normal blood pressure (130 to 139/85 to 89 mm Hg), those who are overweight or obese, and African Americans,” noted the report. “Adults aged 18 to 39 years with normal blood pressure (<130/85 mm Hg) who do not have other risk factors should be rescreened every 3 to 5 years.”

The Task Force noted, “Moderate- to high-quality randomized, controlled trials (RCTs) demonstrate the efficacy of treatment of the general population of persons aged 60 years or older to a target blood pressure of 150/90 mm Hg in reducing the incidence of stroke, heart failure, and coronary heart disease events. Similarly, RCTs demonstrate the efficacy of treatment of younger adults to a target diastolic blood pressure of less than 90 mm Hg in reducing cerebrovascular events, heart failure, and overall mortality.” Clinicians are encouraged to refer to updated hypertension treatment guidelines after results from the Systolic Blood Pressure Intervention Trial are made available which indicate the benefit of lower blood pressure goals of therapy.

Martha Gulati, MD, MS, FACC, editor-in-chief of CardioSmart.org, provides the following advice to patients:

• Accuracy of a single blood pressure reading in an office setting may not be an accurate assessment of blood pressure.
• Use of ambulatory blood pressure monitoring or home blood pressure assessment is a useful verification of blood pressure.
• Currently, targets for blood pressure control are not well-established but more information to guide target goals is expected from the SPRINT Trial. 

Keywords: Adult, African Americans, Blood Pressure, Blood Pressure Determination, Blood Pressure Monitoring, Ambulatory, Coronary Disease, Goals, Heart Failure, Hypertension, Incidence, Leadership, Obesity, Office Visits, Outpatients, Overweight, Risk Factors, Stroke, United States, White Coat Hypertension

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