Reaffirmation Recommendation Statement
U.S. Preventive Services Task Force (USPSTF)
This statement is an update of the 2003 U.S. Preventive Services Task Force
(USPSTF) recommendations about high blood pressure screening.
- The U.S. Preventive Services Task Force (USPSTF) makes recommendations about preventive care services for patients without recognized signs or symptoms of the target condition.
- Recommendations are based on a systematic review of the evidence of the benefits and harms and an assessment of the net benefit of the service.
- The USPSTF recognizes that clinical or policy decisions involve more considerations than this body of evidence alone. Clinicians and policymakers should understand the evidence but individualize decisionmaking to the specific patient or situation.
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Contents
Summary of Recommendations and Evidence
Clinical Considerations
Discussion
Recommendations of Others
References
Members of the USPSTF
Summary of Recommendations and Evidence
- The U.S. Preventive Services Task Force (USPSTF) recommends screening for high blood pressure in adults aged 18 and older. (This is a grade "A" recommendation)
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Rationale:
Importance. Hypertension is a very prevalent condition that contributes to significant adverse health outcomes, including premature deaths, heart attacks, renal insufficiency, and stroke.
Detection. The USPSTF found good evidence that blood pressure measurement can identify adults at increased risk for cardiovascular disease due to high blood pressure. (For a summary of the recommendation and its implications for clinical practice, go to "Screening for High Blood Pressure: Clinical Summary of U.S. Preventive Services Task Force Recommendations." For an explanation of the USPSTF grades and levels of certainty, go to Table 1 and Table 2.)
Benefits of detection and early treatment. The USPSTF found good evidence that treatment of high blood pressure in adults substantially decreases the incidence of cardiovascular events.
Harms of detection and early treatment. The USPSTF found good evidence that screening and treatment for high blood pressure causes few major harms.
USPSTF assessment. The USPSTF concludes that there is high certainty that the net benefit of screening for high blood pressure in adults is substantial.
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Clinical Considerations
Patient
population under consideration. This recommendation applies to adults without
known hypertension.
Screening tests. Office
measurement of blood pressure is most commonly done with a sphygmomanometer.
High blood pressure (hypertension) is usually defined in adults as a systolic
blood pressure of 140 mmHg or higher, or a diastolic blood pressure of 90 mmHg
or higher. Because of the variability in individual blood pressure
measurements, it is recommended that hypertension be diagnosed only after 2 or
more elevated readings are obtained on at least 2 visits over a period of 1 to
several weeks.1
Assessment of
risk. The
relationship between systolic blood pressure and diastolic blood pressure and
cardiovascular risk is continuous and graded. The actual level of blood
pressure elevation should not be the sole factor in determining treatment.
Clinicians should consider the patient's overall cardiovascular risk profile,
including smoking, diabetes, abnormal blood lipid values, age, sex, sedentary
lifestyle, and obesity, when making treatment decisions.
Screening
interval. Evidence
is lacking to recommend an optimal interval for screening adults for
hypertension. The seventh report of the Joint National Committee on Prevention,
Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommends
screening every 2 years in persons with blood pressure less than 120/80 mm Hg
and every year with systolic blood pressure of 120 to 139 mm Hg or diastolic
blood pressure of 80 to 90 mm Hg.2
Pharmacological
treatment. Various
pharmacological agents are available to treat high blood pressure. The JNC 7
guidelines for treatment of high blood pressure can be accessed at www.nhlbi.nih.gov/guidelines/hypertension/jncintro.htm.
Nonpharmacological
treatment. Nonpharmacological
therapies, such as reduction of dietary sodium intake, potassium
supplementation, increased physical activity, weight loss, stress management,
and reduction of alcohol intake, are associated with a reduction in blood
pressure. For those who consume large amounts of alcohol (> 20 drinks per week),
studies have shown that reduced drinking decreases blood pressure.
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Discussion
In 2003, the USPSTF reviewed the evidence for screening for
hypertension in adults and found that the benefits outweigh the harms of
screening.1 The benefits of screening for hypertension are well established
and therefore the USPSTF decided to do a targeted literature search. This
literature search focused on finding evidence of the direct benefits of
screening, the harms of screening, and the harms of treatment of
screen-detected or mild to moderate severity hypertension.3 The USPSTF found
no new substantial evidence about the benefits and harms of screening for high
blood pressure that would lead them to change the previous recommendation and
therefore reaffirms its recommendation that clinicians screen for high blood
pressure in adults age 18 years and older. The 2003 recommendation statement,
2003 evidence report, and the current summary of the updated literature search
can be found at www.preventiveservices.ahrq.gov.
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Recommendations of Others
The JNC 7 calls for routine blood pressure measurement at least
once every 2 years for adults with a systolic blood pressure below 120 mm Hg
and a diastolic blood pressure below 80 mm Hg, and every year for systolic
blood pressure 120-139 and diastolic blood pressure 80-89 mm Hg.2
Similar recommendations have been issued by the American
Heart Association (AHA) for adults beginning at age 20 years.4
The American Academy of Family Physicians strongly recommends
that family physicians screen adults aged 18 and older for high blood pressure.5
The American College of Obstetricians and Gynecologists
recommends measuring blood pressure as part of the periodic assessment in women
13 years or older.6
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References
1.
Sheridan S, Pignone M, Donahue K. Screening for high blood pressure: a review
of the evidence for the U.S. Preventive Services Task Force. Am J Prev Med 2003;25:151-8. [PMID: 12880884]
2. Joint
National Committee on Prevention, Detection, Evaluation, and Treatment of High
Blood Pressure. National Heart, Lung, and Blood Institute. Seventh report of
the Joint National Committee on Prevention, Detection, Evaluation, and
Treatment of High Blood Pressure. Hypertension 2003;42:1206-52. [PMID:
14656957]
3. Wolff
T, Miller T. Evidence for the reaffirmation of the U.S. Preventive Services
Task Force recommendation on screening for high blood pressure. Ann Intern Med
2007;147:787-91.
4. Pearson TA, Blair SN, Daniels SR, Eckel RH, Fair JM, Fortmann SP, et al. AHA
Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002
Update: Consensus Panel Guide to Comprehensive Risk Reduction for Adult
Patients Without Coronary or Other Atherosclerotic Vascular Diseases. American
Heart Association Science Advisory and Coordinating Committee. Circulation
2002;106:388-91. [PMID: 12119259]
5. American Academy of Family Physicians. Summary of Recommendations for Clinical Preventive
Services. Revision 6.0; August 2005.
6. ACOG
Committee on Gynecologic Practice. ACOG Committee Opinion No. 357: Primary and
preventive care: periodic assessments. Obstet Gynecol 2006;108:1615-22. [PMID:
17138804]
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Members of the U.S. Preventive Services Task Force
Corresponding Author: Ned Calonge, M.D., M.P.H., Chair, U.S. Preventive Services Task Force, c/o Program Director, USPSTF, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850.
Members of the U.S. Preventive Services Task Force*: are Ned Calonge, MD, MPH, Chair, USPSTF (Chief Medical Officer and State Epidemiologist, Colorado Department of Public Health and
Environment, Denver, CO); Diana B. Petitti, MD, MPH , Vice-chair, USPSTF (Department of Preventive Medicine, Keck School of Medicine, University of Southern
California, Sierra Mare, CA); Thomas G. DeWitt, MD (Carl Weihl Professor of Pediatrics
and Director of the Division of General and Community Pediatrics, Department of
Pediatrics, Children's Hospital Medical Center, Cincinnati, OH); Leon Gordis, MD, MPH, DrPH
(Professor, Epidemiology Department, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD); Kimberly D. Gregory, MD, MPH (Director, Women’s Health
Services Research and Maternal-Fetal Medicine, Department of Obstetrics and
Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA); Russell Harris, MD,
MPH (Professor of Medicine, Sheps Center for Health Services Research,
University of North Carolina School of Medicine, Chapel Hill, NC); George
Isham, MD, MS (HealthPartners, Minneapolis, MN); Michael L. LeFevre, MD, MSPH
(Professor, Department of Family and Community Medicine, University of Missouri School of
Medicine, Columbia, MO); Carol Loveland-Cherry, PhD, RN (Executive Associate Dean, Office of
Academic Affairs, University of Michigan School of Nursing, Ann Arbor, MI); Lucy N. Marion, PhD, RN (Dean and Professor, School
of Nursing, Medical College of Georgia, Augusta, GA); Virginia A. Moyer, MD, MPH (Professor, Department of
Pediatrics, University of Texas Health Science Center, Houston, TX); Judith K.
Ockene, PhD (Professor of Medicine and Chief of Division of Preventive and
Behavioral Medicine, University of Massachusetts Medical School, Worcester,
MA); George
F. Sawaya, MD (Associate
Professor, Department of Obstetrics, Gynecology, and Reproductive Sciences and
Department of Epidemiology and Biostatistics, University of California, San
Francisco, CA); Albert
L. Siu, MD, MSPH (Professor and Chairman, Brookdale Department of Geriatrics
and Adult Development, Mount Sinai Medical Center, New York, NY); Steven M.
Teutsch, MD, MPH (Executive Director, Outcomes Research and Management, Merck
& Company, Inc., West Point, PA); and Barbara P. Yawn, MD, MSPH, MSc (Department of Research, Olmsted Medical Center, Rochester, MN).
*Members of the Task Force at the time this recommendation was finalized. For a list of current Task Force members, go to http://www.ahrq.gov/clinic/uspstfab.htm.
Disclaimer: Recommendations made by the USPSTF are independent of
the U.S. government. They should not be construed as an official position
of the Agency for Healthcare Research and Quality or the U.S.
Department of Health and Human Services.
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Copyright and Source Information
This document is in the public domain within the United States. For
information on reprinting, contact Randie Siegel, Director, Division of
Printing and Electronic Publishing, Agency for Healthcare Research and Quality,
540 Gaither Road, Rockville, MD 20850.
Requests for linking or to incorporate content in electronic resources
should be sent to: info@ahrq.gov.
Source: U.S. Preventive Services Task Force. Screening for high blood pressure: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2007:147-783-786.
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AHRQ Publication No. 08-05105-EF-2
Current as of December 2007
Internet Citation:
U.S. Preventive Services Task Force. Screening for High Blood Pressure: U.S. Preventive Services Task Force Reaffirmation Recommendation Statement. AHRQ Publication No. 08-05105-EF-2, December 2007 First published in Ann Intern Med 2007:147-783-786. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/uspstf07/hbp/hbprr.htm
540 Gaither Road Rockville, MD 20850