The U.S. Preventive Services Working Group (USPSTF) continues to recommend that physicians analyze high blood pressure in all adults 18 years of age and older and confirm a diagnosis of hypertension with blood pressure measurements taken outside the office before starting treatment.
This grade A recommendation is consistent with the 2015 working group recommendation.
Through a process of reaffirmation deliberation, the USPSTF concluded with high certainty that there was a “substantial net benefit” from detecting hypertension in adults in a clinical setting.
The reaffirmation recommendation clarifies that initial screening should be performed with a measurement of blood pressure in the office.
The working group found “convincing” evidence that screening and treatment of hypertension detected in clinical settings substantially reduce cardiovascular events and have little significant harm.
To confirm the diagnosis of hypertension outside the office before starting treatment, outpatient blood pressure monitoring or home blood pressure monitoring is recommended. Blood pressure in the brachial artery should be measured with a validated and accurate device in a sitting position after 5 minutes of rest.
Although evidence on optimal detection intervals is limited, the working group says that “reasonable” options include the detection of hypertension each year for adults 40 years of age or older and for adults at higher risk of hypertension, such as blacks, people with normal blood pressure, or those who are overweight or obesity.
Less frequent screening (every 3 to 5 years) is suitable for adults aged 18 to 39 who do not have an increased risk of hypertension and who have received a previous reading of blood pressure that was within the normal range, according to the working group, led by Alex Krist, MD, MPH, Virginia Commonwealth University, Richmond, Virginia.
“Projection is only the first step”
In a JAMA editorial, Marwah Abdalla, MD, MPH, Irving Medical Center, Columbia University, New York, and co-authors state that the COVID-19 pandemic has shown that “rapid and meaningful innovation in science, healthcare, and society is possible. of the USPSTF will require widespread changes in the way the health care system and other entities detect hypertension.
“However, screening is only the first step in a long way to controlling hypertension. Medicine and society need to implement a variety of proven interventions that are effective in controlling blood pressure on a large scale,” say the editorialists .
“In addition, these efforts must consider how to achieve the success of all people. This will require working to address the roots of structural racism and reduce racial disparities that increase hypertension-related morbidity and mortality for vulnerable populations.” , they add.
“These changes will be an innovation in the way care is provided at both the individual and population levels: lessons can be learned that the health system and society have learned through the response to the COVID-19 pandemic,” Abdalla concludes. and his colleagues.
The USPSTF and Abdalla have not reported any relevant financial relationships. One columnist reported receiving personal fees from Livongo and Cerner and grants from Bristol-Myers Squibb.