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April 27, 2021

Screening for Hypertension in Adults

Author Affiliations
  • 1Associate Editor, JAMA
JAMA. 2021;325(16):1688. doi:10.1001/jama.2021.5288

The US Preventive Services Task Force (USPSTF) has recently published recommendations on screening for high blood pressure in adults.

What Is High Blood Pressure?

High blood pressure, or hypertension, is a common condition that affects nearly half of American adults. Different organizations use slightly different definitions for high blood pressure: the cutoff values for what is considered “high” range from higher than 130/80 mm Hg to higher than 140/90 mm Hg. For the purposes of this recommendation statement, studies using any cutoff to define hypertension were reviewed.

High blood pressure is a major risk factor for cardiovascular disease (which can lead to heart attack and stroke) as well as for chronic kidney disease (which can lead to kidney failure and dialysis). High blood pressure should be initially addressed by changes in lifestyle, such as a low-salt diet, regular exercise, and weight loss for those who are overweight or obese. If lifestyle changes are not enough, many types of medications can be used to treat high blood pressure.

What Tests Are Used to Screen for High Blood Pressure?

Blood pressure is measured by using a blood pressure monitor with an inflatable cuff that ideally goes over the upper arm. Initial screening for high blood pressure is done by checking blood pressure in a clinical setting (office blood pressure measurement). Sometimes, additional blood pressure checks via home blood pressure monitoring (using your own monitor at home) or ambulatory blood pressure monitoring (repeated home blood pressure measurement over a period of 12 to 24 hours) is done to confirm the diagnosis.

What Is the Population Under Consideration for Screening for High Blood Pressure?

This recommendation applies to adults aged 18 years or older who do not already have a diagnosis of high blood pressure.

What Are the Potential Benefits and Harms of Screening for High Blood Pressure in Adults?

The goal of screening for high blood pressure is to reduce the chance of poor health outcomes such as heart attack, stroke, and death. Screening for high blood pressure is an accurate way to diagnose high blood pressure sooner rather than later, which leads to earlier treatment. Therefore, although there is limited direct evidence from studies to link screening for high blood pressure to health outcomes such as heart attack, stroke, or death, there is convincing evidence of an important benefit for screening because of accurate tests and effective treatment.

Potential harms of screening are small and include false-positive results (inaccurate elevated blood pressure readings) that lead to further testing such as ambulatory blood pressure monitoring, which can cause some discomfort for patients.

How Strong Is the Recommendation to Screen for High Blood Pressure in Adults?

Based on current evidence, the USPSTF concludes with high certainty that the net benefit of screening for high blood pressure in adults is substantial.

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Article Information

Conflict of Interest Disclosures: None reported.

Source: US Preventive Services Task Force. Screening for hypertension in adults: US Preventive Services Task Force reaffirmation recommendation statement. JAMA. Published April 27, 2021. doi:10.1001/jama.2021.4987