USPSTF Recommendation Statement on Hypertension Screening in Adults—Where Do We Go From Here?

Compared with other modifiable risk factors, hypertension is associated with more target end-organ damage, cardiovascular disease (CVD) events, and disability-adjusted life-years lost in the United States. 1 The measurement of blood pressure (BP) in the office setting has been the primary method to identify hypertension and assess for BP control. 2 However, this approach may be insufficient, since studies have demonstrated that compared with office BP, BP measurements obtained outside of the office setting are more strongly associated with CVD. 3 In the 2021 US Preventive Services Task Force (USPSTF) recommendation statement by Krist et al, 4 hypertension screening using office BP measurement is recommended for adults aged 18 years or older.Out-of-office BP monitoring is also recommended for diagnostic confirmation before starting treatment.The USPSTF considered this recommendation to be a grade A, indicating there is high certainty that the net benefit of screening for hypertension is substantial.4 The recommendation from the 2021 USPSTF recommendation statement 4 was based on evidence from a systematic review by Guirguis-Blake et al 5 commissioned by the USPSTF to evaluate key questions related to the benefits and harms of screening for hypertension in adults, the accuracy of office BP measurement for initial screening, and the accuracy of various confirmatory BP measurement methods after an initial high office BP.Regarding benefits of hypertension screening, the systematic review by Guirguis-Blake et al 5 identified 1 good-quality community-based randomized clinical trial conducted in Canada examining the effectiveness of a 10-week multicomponent CVD health promotion program intervention with hypertension screening as a primary component on CVD outcomes (ie, the change in mean annual rate of hospital admissions for acute myocardial infarction, heart failure, or stroke in the year before compared with the year after intervention implementation) among residents 65 years or older.BP was measured by trained volunteers using a validated device.Compared with no intervention, the intervention led to a 9% reduction in hospitalizations per 1000 CVD events.The systematic review by Guirguis-Blake et al 5 also identified a few studies on the harms of hypertension screening.Data from these studies suggested minimal associations of hypertension screening with quality of life and psychological outcomes.For many people, BP differs when measured outside vs inside the office.Two BP phenotypes represent a mismatch between office and out-of-office BP: white coat hypertension and masked hypertension.White coat hypertension is defined by having high office BP and not having high out-ofoffice BP, and masked hypertension is defined by having high out-of-office BP and not having high office BP.2,3 Compared with sustained normotension, defined by not having high BP on either in-office or out-of-office BP measurements, white coat hypertension is associated with either no increased or moderately increased risk of CVD and mortality.2,6 Prior studies have also shown that compared with sustained normotension, masked hypertension is associated with an increased risk of CVD and mortality.2,3 White coat hypertension and masked hypertension can only be excluded by performing office measurements and out-of-office BP monitoring.There are 2 standard approaches to out-of-office BP monitoring: ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM).3 ABPM is a fully automated technique in which BP is recorded typically over a 24-hour period, while HBPM involves the self-measurement of BP by an individual at home.Prior hypertension guidelines, including the 2015 USPSTF recommendation + Multimedia +

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