Importance of High Blood Pressure Screening Reaffirmed
With the latest review of its recommendations for high blood pressure screenings, the US Preventive Services Task Force (USPSTF) has reaffirmed the importance of all adults aged 18 years and older getting regular blood pressure checks. The 2021 recommendations restate and clarify those that were last updated in 2015.
High blood pressure is a common but serious health issue in the U.S. About 45% of adult Americans have high blood pressure (hypertension), and many of them don’t know it. The condition is more common in African Americans and affects more men than women. Other factors that can put you at higher risk for the condition include older age, being overweight or obese, lack of exercise, stress, and tobacco use.
High blood pressure rarely causes symptoms and, without screenings, it is possible to have it for many years without realizing it. Over time and without treatment, elevated blood pressure can lead to other serious health problems, including increased risk of heart disease and stroke, and chronic kidney disease.
Data is limited on how often adults should be screened, according to the USPSTF. However, the Task Force suggests that those 40 years of age and older as well as those with risk factors be screened annually, while those 18 to 39 years of age and without risk could be screened every three to five years.
With today’s technology, people have a few different options for getting their blood pressure checked. Options range from convenient home-monitoring equipment to automated devices (sphygmomanometers) used in many outpatient settings. Given these choices, the USPSTF’s latest statement clarifies that blood pressure screenings should take place in healthcare providers’ offices. For most of the studies that the Task Force reviewed for their recommendation, office measurements were most commonly taken using a manual or automated sphygmomanometer placed at the upper arm, with the patient seated and at rest for 5 minutes.
If these office readings are elevated, the USPSTF reaffirms that blood pressure should be measured outside the clinical setting to confirm a diagnosis and before a patient begins treatment with medications. Readings from outside the clinical setting can help rule out white coat syndrome, which is high measurements that are present only when you are in the doctor’s office and not at other times. For measurement take outside a clinical setting, the USPSTF recommends one of two options using devices that have been shown to take accurate readings:
- Ambulatory blood pressure monitoring–this involves wearing a device that automatically measures your blood pressure several times a day or sometimes over a day and a night.
- Home blood pressure monitoring–you measure your own blood pressure at home with a validated device.
Various health organizations have different cutoffs for diagnosing high blood pressure, ranging from 130/80 millimeters of mercury (mm Hg) or greater to 140/90 mm Hg or greater. For patients diagnosed with mild hypertension, treatment may be limited to lifestyle changes like eating a healthy diet, exercising and losing excess weight. This may be enough to bring blood pressure to within normal limits. However, some patients may need one or more of several medications that are used to control high blood pressure.
Among the areas that require more research, notes the USPSTF, are white coat syndrome and masked hypertension, which is normal blood pressure readings at the office but elevated readings at other times. Studies may show how common these cases are, and whether detecting them through regular screening and treating them can help prevent heart disease or other conditions. Also, additional studies that include more diverse populations are needed.
US Preventive Services Task Force. Screening for Hypertension in Adults: US Preventive Services Task Force Reaffirmation Recommendation Statement. JAMA. 2021;325(16):1650–1656. doi:10.1001/jama.2021.4987. Accessed May 18, 2021. https://jamanetwork.com/journals/jama/fullarticle/2779190