Blood pressure screening
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Blood Pressure Screening: Insights and Recommendations
Importance of Blood Pressure Screening
Blood pressure (BP) screening is crucial as nearly one in three U.S. adults has high blood pressure, with the prevalence increasing to two-thirds among those aged 60 years or older. Elevated BP is a significant risk factor for all-cause and cardiovascular mortality1. Effective screening and management of high BP can substantially reduce the incidence of cardiovascular events2.
Screening Methods and Diagnostic Accuracy
Office Blood Pressure Measurement (OBPM)
OBPM is a common method for detecting hypertension. Studies have shown that OBPM can effectively identify elevated BP, but its accuracy can be influenced by various factors, including the measurement protocol and the environment1 4. The U.S. Preventive Services Task Force (USPSTF) recommends confirming an initial high BP reading with measurements taken outside the clinical setting before starting treatment4.
Ambulatory and Home Blood Pressure Monitoring
Ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM) are increasingly used to confirm elevated BP detected by OBPM. ABPM, in particular, has been identified as the best predictor of cardiovascular events, providing a more comprehensive assessment of BP throughout the day1. These methods help reduce measurement errors and provide a more accurate diagnosis1 4.
Rescreening Intervals
Determining the optimal rescreening interval is essential for effective BP management. Studies suggest that rescreening intervals should be based on initial BP levels and other cardiovascular risk factors. Regular rescreening can help identify individuals who develop hypertension over time, ensuring timely intervention1.
Benefits and Harms of Screening
Adults
Screening for high BP in adults has been shown to reduce cardiovascular events significantly. The USPSTF reaffirms the recommendation to screen adults aged 18 years or older, emphasizing the importance of early detection and treatment4 10. The benefits of screening outweigh the potential harms, which are minimal and primarily related to the psychological impact of being labeled hypertensive2.
Children and Adolescents
The prevalence of hypertension in children is increasing, and it often persists into adulthood. However, there is insufficient evidence to conclude that screening children and adolescents for hypertension reduces adverse cardiovascular outcomes in adults6 7. Current guidelines recommend BP screening during preventive care visits and emphasize the need for further research to improve diagnosis and risk stratification in this population3 6.
Global Screening Initiatives
May Measurement Month (MMM)
The International Society of Hypertension's May Measurement Month (MMM) campaign aims to raise awareness of high BP and address the lack of formal screening programs worldwide. The 2018 campaign screened over 1.5 million individuals across 89 countries, identifying a significant number of untreated or inadequately treated hypertensive individuals5 9. Such initiatives highlight the importance of global efforts to improve BP awareness and management.
Conclusion
Blood pressure screening is a vital public health measure that can significantly reduce the burden of cardiovascular disease. Accurate measurement methods, appropriate rescreening intervals, and global awareness campaigns are essential components of effective BP management. While screening in adults is well-supported by evidence, further research is needed to establish the benefits of screening in children and adolescents.
Sources and full results
Most relevant research papers on this topic
Diagnostic and Predictive Accuracy of Blood Pressure Screening Methods With Consideration of Rescreening Intervals: A Systematic Review for the U.S. Preventive Services Task Force
Newer blood pressure screening methods and rescreening intervals could improve the benefits and efficiency of screening for high blood pressure in adults aged 18 years or older.
Systematic Review
Rigorous Journal
Highly CitedScreening for high blood pressure: a review of the evidence for the U.S. Preventive Services Task Force.
Screening adults for hypertension and treating it effectively can reduce cardiovascular disease risk, with no significant adverse effects on psychological well-being or absenteeism rates.
Systematic ReviewHighly CitedClinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents
This updated pediatric hypertension guideline simplifies screening and management, aligns with adult guidelines, and promotes patient-centered care.
Highly CitedScreening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement.
The USPSTF recommends screening for high blood pressure in adults aged 18 years and older, with obtaining outside measurements for diagnostic confirmation before starting treatment.
Rigorous JournalHighly CitedMay Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension
May Measurement Month 2018, an expanded global campaign, identified over 335 000 adults with untreated or inadequately treated hypertension, effectively raising awareness among those at risk.
Observational StudyRigorous JournalHighly CitedScreening for Hypertension in Children and Adolescents to Prevent Cardiovascular Disease
Screening for hypertension in children and adolescents does not directly reduce adverse cardiovascular outcomes in adults.
Systematic ReviewHighly CitedThe USPSTF call to inaction on blood pressure screening in children and adolescents
The USPSTF's insufficient evidence for blood pressure screening in children and adolescents contradicts evidence linking higher BP levels in childhood to increased cardiovascular disease risk in early adulthood.
Systematic ReviewPerformance of User-Friendly Screening Tools for Elevated Blood Pressure in Children
User-friendly screening tools, such as BP-to-height ratio and age-based tables, can improve the detection of elevated blood pressure in children.
Meta-AnalysisMay Measurement Month 2017: an analysis of blood pressure screening results worldwide.
May Measurement Month 2017 successfully achieved inexpensive global blood pressure screening using volunteers and convenience sampling, highlighting the need for annual awareness campaigns.
Observational StudyRigorous JournalHighly CitedScreening for high blood pressure: U.S. Preventive Services Task Force reaffirmation recommendation statement.
The U.S. Preventive Services Task Force reaffirms its recommendation to screen for high blood pressure in adults aged 18 years or older, based on the latest evidence on benefits and harms.
Highly Cited