Screening for Hypertension

A grade A recommendation calls for blood pressure screening of adults aged 18 and older.

The U.S. Preventive Services Task Force (USPSTF) has been releasing new and updated guidelines periodically. Along with the release of this recommendation statement, the USPSTF has revised the way it grades its recommendations to make them more clinically useful.

Recommendations concern preventive care for patients without recognized signs or symptoms of a given condition. The USPSTF now grades the recommendations as follows (descriptions of levels of certainty can be found at the guidelines home page):

A — The service is recommended. High certainty that benefit is substantial.

B — The service is recommended. High certainty that benefit is moderate, or moderate certainty that benefit is moderate to substantial.

C — The USPSTF recommends against providing the service routinely. Moderate certainty that the benefit is small. Considerations may support providing the service to individual patients.

D — The USPSTF recommends against the service. Moderate to high certainty of no benefit or that the harms outweigh the benefits.

I — Evidence is insufficient to assess the balance of benefits and harms.

The USPSTF also now provides suggestions for practice: For Grade A or B recommendations, offer the service; Grade C, offer the service only based on individual considerations; Grade D, discourage the service; Grade I, if the service is offered (e.g., based on clinical considerations), patients should understand the uncertainty about the benefits and harms.

The USPSTF has published an updated practice guideline that recommends screening for high blood pressure in adults (age, 18). The recommendation is graded "A," which means net benefit is substantial and is based on well-designed, well-conducted studies in representative primary care populations that assess the effects of screening on health outcomes. Identification of adults with high blood pressure allows treatment that can decrease their risk for cardiovascular events.

In a systematic literature review, the task force found no new evidence (since 2001) on the benefits or harms of screening; reviewers identified five randomized trials that provided information on the harms of early treatment of asymptomatic hypertension (i.e., screening-identified). Adverse effects of medications were very common, but serious adverse events occurred in 11% of adults.

The optimal interval for screening has not been determined, but the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends screening every 2 years if blood pressure is <120/80 mm Hg and every year if systolic pressure is 120 to 139 mm Hg or diastolic pressure is 80 to 90 mm Hg.

Comment: Sometimes the USPSTF recommends against providing preventive services routinely because the evidence of health benefit has not been proven. In the case of hypertension screening, the evidence is clear and robust. Blood pressure is checked at just about every healthcare encounter, but striving for good blood pressure control is the best way to use these guidelines to help patients.

— Richard Saitz, MD, MPH, FACP, FASAM

Published in Journal Watch General Medicine January 8, 2008

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