Screening

The vast majority of hypertensive patients will be detected during an asymptomatic screening during some contact with the medical system. The US Preventive Services Task Force (USPSTF) has recommended annual screening for adults aged ≥40 years or for those at increased risk for high blood pressure (BP) (high-normal BP, overweight or obese, or African-American). Adults aged 18-39 years with normal BP without other risk factors were advised to be re-screened every 3-5 years.[67] The American College of Cardiology (ACC)/American Heart Association (AHA) guideline, however, recommends annual screening in all patients with normal BP.[2] Measurements should be obtained outside of the clinical setting (ambulatory blood pressure monitoring [ABPM] or home blood pressure monitoring [HBPM]) to confirm the diagnosis.[2][67]​​​ If a patient has an untreated systolic BP >130 mmHg but <160 mmHg or diastolic BP >80 mmHg but <100 mmHg, it is reasonable to screen for the presence of white-coat hypertension by using either daytime ABPM or HBPM before diagnosis of hypertension.[2] In adults with elevated clinic BP (120-129/<80 mmHg) but not meeting the criteria for hypertension, screening for masked hypertension with daytime ABPM or HBPM is reasonable. Guidelines for other countries may recommend different screening intervals. The 2024 ESC guideline recommends annual screening for individuals with raised BP (120-139 mmHg systolic or 70-89 mmHg diastolic) or for those aged ≥40 years. For individuals aged <40 years with non-elevated BP, screening is recommended at least every 3 years.[1]

These screening guidelines are often exceeded, as BP measurement is standard for each encounter in many practice settings. Elevated readings should always be confirmed on a second visit prior to diagnosing hypertension.

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