The final Research Plan is used to guide a systematic review of the evidence by researchers at an Evidence-based Practice Center. The resulting Evidence Report will form the basis of the USPSTF Recommendation Statement on this topic.

The draft Research Plan was available for comment from June 20 until July 17, 2013 at 5:00 p.m., ET.

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*Elevated blood pressure is defined as the threshold for pharmacologic treatment.

Abbreviations: ABPM = ambulatory blood pressure monitoring; BP = blood pressure; CHD = coronary heart disease; CVD = cardiovascular disease; HF = heart failure; ESKD = end-stage kidney disease; HBPM = home blood pressure monitoring.

1. Does screening for high blood pressure reduce cardiovascular disease and mortality in adults age 18 years or older?
2. What is the best way to screen for high blood pressure in adults in the primary care setting*?
   1. How accurate (i.e., sensitivity, specificity, predictive value) are clinic-based blood pressure measurement methods (e.g., manual vs. automated) in diagnosing hypertension within a single visit?
   2. What screening protocol characteristics within a single encounter (e.g., sitting quietly for 5 minutes, number of readings) define the best diagnostic accuracy?
3. What is the best way to confirm hypertension in adults who initially screen positive for high blood pressure?
   1. How well do home and ambulatory blood pressure monitoring methods predict cardiovascular events compared with clinic-based blood pressure measurement methods? What confirmation protocol characteristics define the best prediction of cardiovascular events? Which methods and associated protocols best predict cardiovascular events?
   2. How accurate are other noninvasive blood pressure measurement methods in establishing or confirming the diagnosis of hypertension compared with these best methods and associated protocols? Does diagnostic accuracy vary by protocol characteristics (i.e., characteristics not reviewed in Key Question 2b, such as the number of visits)?
   3. Does changing the measurement method from that used during the initial screening improve diagnostic accuracy for some specific patient subgroups (e.g., those with suspected white coat hypertension)?
4. What is the clinically appropriate rescreening interval for patients who have previously been screened and found to have normal blood pressure?
   1. What is the shortest interval in which clinically significant, diagnosed hypertension may develop?
   2. Does the rescreening interval vary by patient characteristics (e.g., age, sex, race/ethnicity, cardiovascular risk, blood pressure level, screening history)?
5. What are the adverse effects of screening for high blood pressure in adults?

*For this review, eligible primary care settings must have personnel trained in blood pressure measurement, established blood pressure measurement protocols, and ongoing documentation procedures for each (e.g., internal medicine, family practice, obstetrics/gynecology, school- and military-based health clinics, pharmacies, retail and mobile clinics, dental offices).

Contextual questions will not be systematically reviewed and are not shown in the Analytic Framework.

1. What is the diagnostic accuracy of automated and nonautomated blood pressure measurement instruments in the community setting (e.g., grocery store and pharmacy kiosks, community health fairs) that are not associated with an attendant, trained personnel, or established procedures? What are the characteristics of patients for whom these automated kiosks may be acceptable (e.g., non-obese)?
2. Is there a valid protocol for identifying patients who are likely to have white coat hypertension?

The Research Approach identifies the study characteristics and criteria that the Evidence-based Practice Center will use to search for publications and to determine whether identified studies should be included or excluded from the Evidence Report. Criteria are overarching as well as specific to each of the key questions (KQs).

The draft Research Plan was posted for public comment on the U.S. Preventive Services Task Force (USPSTF) Web site from June 20 to July 17, 2013; 18 individuals and organizations provided comments. The USPSTF received comments suggesting that operational definitions of normal blood pressure, elevated blood pressure, and hypertension be included. In the Analytic Framework, elevated blood pressure is now generally defined as the threshold for pharmacologic treatment. The review will include additional detail noting that this value is derived from guidelines for various populations and that the threshold varies by measurement method. A “high-normal” blood pressure category was added as a third possible result after screening, with lifestyle counseling as a possible intervention before entering the rescreening loop in the Analytic Framework (evidence to be summarized in the review). Key Question 2a (screening) was changed to “provisionally diagnosing hypertension” to remain consistent with wording in Key Question 3b (“establishing or confirming the diagnosis of hypertension”). Minor changes were made to the Research Plan in order to clarify the inclusion and exclusion criteria in response to a variety of comments. Additional comments addressed issues already covered by the Key Questions, treatment questions that this review will not address, minor clarifications, or potentially important contextual issues or discussion points. These comments did not warrant changes to the Research Plan but will be considered in the preparation of the evidence review and report.