Chronic hypertension screening
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]: Associate Editor(s)-in-Chief: Yazan Daaboul, Serge Korjian
Overview
The age to begin screening for hypertension varies between 13-20 years of age, according to different authorities. Generally, hypertension is defined as SBP > 140 mmHg and/or DBP > 90 mmHg. In specific populations, however, routine follow-up target BP may be different; and initiation of treatment may be considered at even lower BP values than those considered for the normal population.
Screening
The age to start screening for hypertension varies according to different authorities:
| Authority | Age to Start Screening for Hypertension |
| The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)[1] | 20 years |
| American Heart Association (AHA)[2] | 20 years |
| American Academy of Family Physicians (AAFP)[3] | 18 years |
| American College of Obstetricians and Gynecologists (ACOG)[4] | 13 years |
The U.S. Preventive Services Task Force (USPSTF)[5] and JNC 7[1] Screening Recommendations
- If SBP < 120 mmHg and DBP < 80 mmHg: Screening is recommended every 2 years
- If SBP = 120-139 mmHg and/or DBP = 80-89 mmHg: Screening is recommended yearly
- If SBP = 140-159 mmHg and/or DBP = 90-99 mmHg: Confirmation of BP values within 2 months is required
- If SBP = 160-180 mmHg and/or DBP > 110 mmHg: Evaluation or referral to source of care within 1 month
- If SBP > 180 mmHg: Evaluation and treatment immediately or within 1 week. Clinical situation and complications are to be taken into major consideration.
2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults
Secondary Forms of Hyperpertension
| Class I |
| "1. Screening for specific form(s) of secondary hypertension is recommended when the clinical indications and physical examination findings are present or in adults with resistant hypertension.(Level of Evidence: C-EO) " |
| Class IIb |
| "1. If an adult with sustained hypertension screens positive for a form of secondary hypertension, referral to a physician with expertise in that form of hypertension may be reasonable for diagnostic confirmation and treatment. (Level of Evidence: C-EO) " |
Primary Aldosteronism
| Class I |
| "1. In adults with hypertension, screening for primary aldosteronism is recommended in the presence of any of the following concurrent conditions: resistant hypertension, hypokalemia (spontaneous or substantial, if diuretic induced), incidentally discovered adrenal mass, family history of early-onset hypertension, or stroke at a young age (<40 years).(Level of Evidence: C-EO) " |
| "2. Use of the plasma aldosterone: renin activity ratio is recommended when adults are screened for primary aldosteronism.(Level of Evidence: C-LD) " |
| "3. In adults with hypertension and a positive screening test for primary aldosteronism, referral to a hypertension specialist or endocrinologist is recommended for further evaluation and treatment.(Level of Evidence: C-EO) " |
Renal Artery Stenosis
| Class I |
| "1. Medical therapy is recommended for adults with atherosclerotic renal artery stenosis.(Level of Evidence: A) " |
| Class IIb |
| "1. In adults with renal artery stenosis for whom medical management has failed (refractory hypertension, worsening renal function, and/or intractable HF) and those with nonatherosclerotic disease, including fibromuscular dysplasia, it may be reasonable to refer the patient for consideration of revascularization (percutaneous renal artery angioplasty and/or stent placement). (Level of Evidence: C-EO) " |
Obstructive Sleep Apnea
| Class IIb |
| "1. In adults with hypertension and obstructive sleep apnea, the effectiveness of continuous positive airway pressure (CPAP) to reduce BP is not well established. (Level of Evidence: B-R) " |
References
- ↑ 1.0 1.1 Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL; et al. (2003). "Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure". Hypertension. 42 (6): 1206–52. doi:10.1161/01.HYP.0000107251.49515.c2. PMID 14656957.
- ↑ Pearson TA, Blair SN, Daniels SR, Eckel RH, Fair JM, Fortmann SP; et al. (2002). "AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 Update: Consensus Panel Guide to Comprehensive Risk Reduction for Adult Patients Without Coronary or Other Atherosclerotic Vascular Diseases. American Heart Association Science Advisory and Coordinating Committee". Circulation. 106 (3): 388–91. PMID 12119259.
- ↑ U.S. Preventive Services Task Force (2007). "Screening for high blood pressure: U.S. Preventive Services Task Force reaffirmation recommendation statement". Ann Intern Med. 147 (11): 783–6. PMID 18056662.
- ↑ ACOG Committee on Gynecologic Practice (2006). "ACOG Committee Opinion No. 357: Primary and preventive care: periodic assessments". Obstet Gynecol. 108 (6): 1615–22. PMID 17138804.
- ↑ Ferket BS, Colkesen EB, Visser JJ, Spronk S, Kraaijenhagen RA, Steyerberg EW; et al. (2010). "Systematic review of guidelines on cardiovascular risk assessment: Which recommendations should clinicians follow for a cardiovascular health check?". Arch Intern Med. 170 (1): 27–40. doi:10.1001/archinternmed.2009.434. PMID 20065196.