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) recommended yearly 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 to 39 years with normal blood pressure (<130/85 mmHg) without other risk factors were advised to be rescreened every 3 to 5 years. The American College of Cardiology/American Heart Association (ACC/AHA) guideline, however, recommends annual screening in all patients with normal blood pressure.[5] The USPSTF recommended obtaining measurements outside of the clinical setting (ambulatory blood pressure monitoring[58] or home BP) to confirm the diagnosis.[46] The ACC/AHA guideline reinforces this recommendation differing only in the threshold. If a patient has an untreated systolic blood pressure >130 mmHg but <160 mmHg or diastolic blood pressure >80 mmHg but <100 mmHg, it is reasonable to screen for the presence of white-coat hypertension by using either daytime ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) before diagnosis of hypertension.[5] In adults with elevated office blood pressure (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 European Society of Cardiology/European Society of Hypertension guideline recommends annual screening for patients with high-normal BP 130 to 139/85 to 89 mmHg, at least every 3 years for patients with normal BP 120 to 129/80 to 84 mmHg and at least every 5 years for patients with optimal BP <120/80 mmHg.[2]

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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