The United States Preventive Services Task Force (USPSTF) recommends that adults aged 18 years and older be screened for high blood pressure, and that patients obtain measurements outside of the clinic setting to confirm a hypertension diagnosis.
High blood pressure is the most common diagnosis in outpatient office visits, affecting approximately 30% of the entire adult population. The prevalence of hypertension increases with age — affecting 7.3% of individuals aged 18 to 39 years, 3.4% of individuals aged 40 to 59 years, and 65% of individuals aged 60 years or older.
The USPSTF updated the 2007 recommendation by examining the accuracy of office blood pressure measurements, ambulatory blood pressure monitoring (ABPM), and home blood pressure monitoring (HBPM).
Researchers analyzed 9 studies that evaluated the harms of blood pressure screenings, 4 of which found no psychological distress changes before and after participants were labeled with hypertension. An additional 4 studies found that ABPM was associated with some sleep disturbances, discomfort, or restrictions in daily activities, which the task force concluded suggests that the harms of screening are very minor.
The USPSTF notes that diagnosing hypertension only in the clinic setting can lead to measurement errors, a smaller number of measurements, and white coat hypertension.
Their recommendation stated that, “Given the variability of office blood pressure in predicting sustained, true hypertension, confirmatory measurement is needed for the patients with elevated blood pressure at the initial office screening.”
The USPSTF recommended using ABPM as the standard reference to confirm hypertension because it records 24-hour blood pressure averages. They also found that increased ambulatory blood pressure was associated with increased risk for stroke and cardiovascular events.
HBPM is another acceptable method to confirm hypertension and should be used if patients cannot use ABPM, but fewer studies have compared HBPM with office blood pressure. Both methods can be used to confirm hypertension diagnoses.
Adults aged 40 years or older who have high-normal blood pressure (130-139/85-89 mm Hg) should be screened annually. Adults aged 18 to 39 years of age with normal blood pressure should be screened every 3 to 5 years.
Individuals 60 years or older with hypertension should have a target blood pressure of 150/90 mm Hg to reduce the incidence of stroke, heart failure, and coronary heart disease, the guidelines stated. Younger adults should have a target blood pressure of less than 90 mm Hg to reduce cerebrovascular events, heart failure, and mortality rates.
Treatment options for hypertension include thiazide diuretics, calcium-channel blockers, angiotensin-converting enzyme inhibitors, or an angiotensin-receptor blockers.