Reaffirmation Recommendation Statement

This statement is an update of the 2003 U.S. Preventive Services Task Force (USPSTF) recommendations about high blood pressure screening.

• The U.S. Preventive Services Task Force (USPSTF) makes recommendations about preventive care services for patients without recognized signs or symptoms of the target condition.
• Recommendations are based on a systematic review of the evidence of the benefits and harms and an assessment of the net benefit of the service.
• The USPSTF recognizes that clinical or policy decisions involve more considerations than this body of evidence alone. Clinicians and policymakers should understand the evidence but individualize decisionmaking to the specific patient or situation.

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Importance. Hypertension is a very prevalent condition that contributes to significant adverse health outcomes, including premature deaths, heart attacks, renal insufficiency, and stroke.

Detection. The USPSTF found good evidence that blood pressure measurement can identify adults at increased risk for cardiovascular disease due to high blood pressure. (For a summary of the recommendation and its implications for clinical practice, go to "Screening for High Blood Pressure: Clinical Summary of U.S. Preventive Services Task Force Recommendations." For an explanation of the USPSTF grades and levels of certainty, go to Table 1 and Table 2.)

Benefits of detection and early treatment. The USPSTF found good evidence that treatment of high blood pressure in adults substantially decreases the incidence of cardiovascular events.

Harms of detection and early treatment. The USPSTF found good evidence that screening and treatment for high blood pressure causes few major harms.

USPSTF assessment. The USPSTF concludes that there is high certainty that the net benefit of screening for high blood pressure in adults is substantial.

Patient population under consideration. This recommendation applies to adults without known hypertension.

Screening tests. Office measurement of blood pressure is most commonly done with a sphygmomanometer. High blood pressure (hypertension) is usually defined in adults as a systolic blood pressure of 140 mmHg or higher, or a diastolic blood pressure of 90 mmHg or higher. Because of the variability in individual blood pressure measurements, it is recommended that hypertension be diagnosed only after 2 or more elevated readings are obtained on at least 2 visits over a period of 1 to several weeks.¹

Assessment of risk. The relationship between systolic blood pressure and diastolic blood pressure and cardiovascular risk is continuous and graded. The actual level of blood pressure elevation should not be the sole factor in determining treatment. Clinicians should consider the patient's overall cardiovascular risk profile, including smoking, diabetes, abnormal blood lipid values, age, sex, sedentary lifestyle, and obesity, when making treatment decisions.

Screening interval. Evidence is lacking to recommend an optimal interval for screening adults for hypertension. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommends screening every 2 years in persons with blood pressure less than 120/80 mm Hg and every year with systolic blood pressure of 120 to 139 mm Hg or diastolic blood pressure of 80 to 89 mm Hg.²

Pharmacological treatment. Various pharmacological agents are available to treat high blood pressure. The JNC 7 guidelines for treatment of high blood pressure can be accessed at www.nhlbi.nih.gov/guidelines/hypertension/jncintro.htm.

Nonpharmacological treatment. Nonpharmacological therapies, such as reduction of dietary sodium intake, potassium supplementation, increased physical activity, weight loss, stress management, and reduction of alcohol intake, are associated with a reduction in blood pressure. For those who consume large amounts of alcohol (>20 drinks per week), studies have shown that reduced drinking decreases blood pressure

In 2003, the USPSTF reviewed the evidence for screening for hypertension in adults and found that the benefits outweigh the harms of screening.¹ The benefits of screening for hypertension are well established and therefore the USPSTF decided to do a targeted literature search. This literature search focused on finding evidence of the direct benefits of screening, the harms of screening, and the harms of treatment of screen-detected or mild to moderate severity hypertension.³ The USPSTF found no new substantial evidence about the benefits and harms of screening for high blood pressure that would lead them to change the previous recommendation and therefore reaffirms its recommendation that clinicians screen for high blood pressure in adults age 18 years and older. The 2003 recommendation statement, 2003 evidence report, and the current summary of the updated literature search can be found at https://www.uspreventiveservicestaskforce.org.

The JNC 7 calls for routine blood pressure measurement at least once every 2 years for adults with a systolic blood pressure below 120 mm Hg and a diastolic blood pressure below 80 mm Hg, and every year for systolic blood pressure 120-139 and diastolic blood pressure 80-89 mm Hg.²

Similar recommendations have been issued by the American Heart Association (AHA) for adults beginning at age 20 years.⁴

The American Academy of Family Physicians strongly recommends that family physicians screen adults aged 18 and older for high blood pressure.⁵

The American College of Obstetricians and Gynecologists recommends measuring blood pressure as part of the periodic assessment in women 13 years or older.⁶

Corresponding Author: Ned Calonge, M.D., M.P.H., Chair, U.S. Preventive Services Task Force, c/o Program Director, USPSTF, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850.

Members of the U.S. Preventive Services Task Force*: are Ned Calonge, MD, MPH, Chair, USPSTF (Chief Medical Officer and State Epidemiologist, Colorado Department of Public Health and Environment, Denver, CO); Diana B. Petitti, MD, MPH, Vice-chair, USPSTF (Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Sierra Mare, CA); Thomas G. DeWitt, MD (Carl Weihl Professor of Pediatrics and Director of the Division of General and Community Pediatrics, Department of Pediatrics, Children's Hospital Medical Center, Cincinnati, OH); Leon Gordis, MD, MPH, DrPH (Professor, Epidemiology Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD); Kimberly D. Gregory, MD, MPH (Director, Women's Health Services Research and Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA); Russell Harris, MD, MPH (Professor of Medicine, Sheps Center for Health Services Research, University of North Carolina School of Medicine, Chapel Hill, NC); George Isham, MD, MS (HealthPartners, Minneapolis, MN); Michael L. LeFevre, MD, MSPH (Professor, Department of Family and Community Medicine, University of Missouri School of Medicine, Columbia, MO); Carol Loveland-Cherry, PhD, RN (Executive Associate Dean, Office of Academic Affairs, University of Michigan School of Nursing, Ann Arbor, MI); Lucy N. Marion, PhD, RN (Dean and Professor, School of Nursing, Medical College of Georgia, Augusta, GA); Virginia A. Moyer, MD, MPH (Professor, Department of Pediatrics, University of Texas Health Science Center, Houston, TX); Judith K. Ockene, PhD (Professor of Medicine and Chief of Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA); George F. Sawaya, MD (Associate Professor, Department of Obstetrics, Gynecology, and Reproductive Sciences and Department of Epidemiology and Biostatistics, University of California, San Francisco, CA); Albert L. Siu, MD, MSPH (Professor and Chairman, Brookdale Department of Geriatrics and Adult Development, Mount Sinai Medical Center, New York, NY); Steven M. Teutsch, MD, MPH (Executive Director, Outcomes Research and Management, Merck & Company, Inc., West Point, PA); and Barbara P. Yawn, MD, MSPH, MSc (Department of Research, Olmsted Medical Center, Rochester, MN).

*Members of the Task Force at the time this recommendation was finalized. For a list of current Task Force members, go to https://www.uspreventiveservicestaskforce.org/uspstf/about-uspstf/current-members.

Disclaimer: Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

This document is in the public domain within the United States.

Requests for linking or to incorporate content in electronic resources should be sent via the USPSTF contact form.

Source: U.S. Preventive Services Task Force. Screening for high blood pressure: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2007:147-783-786.

* The USPSTF defines certainty as "likelihood that the USPSTF assessment of the net benefit of a preventive service is correct." The net benefit is defined as benefit minus harm of the preventive service as implemented in a general, primary care population. The USPSTF assigns a certainty level based on the nature of the overall evidence available to assess the net benefit of a preventive service.