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Clinical Summary

High Blood Pressure in Adults: Screening

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.

Clinical Summary of U.S. Preventive Services Task Force Recommendation

Clinical Summary of U.S. Preventive Services Task Force Recommendation

Population Adults aged ≥18 y without known hypertension
Recommendation Screen for high blood pressure; obtain measurements outside of the clinical setting for diagnostic confirmation.
Grade: A
Risk Assessment Persons at increased risk for high blood pressure are those who have high-normal blood pressure (130–139/85–89 mm Hg), those who are overweight or obese, and African Americans.
Screening Tests Office measurement of blood pressure is done with a manual or automated sphygmomanometer. Proper protocol is to use the mean of 2 measurements taken while the patient is seated, allow for ≥5 min between entry into the office and blood pressure measurement, use an appropriately sized arm cuff, and place the patient's arm at the level of the right atrium. Multiple measurements over time have better positive predictive value than a single measurement.

Ambulatory and home blood pressure monitoring can be used to confirm a diagnosis of hypertension after initial screening.

Screening Interval Adults aged ≥40 y and persons at increased risk for high blood pressure should be screened annually. Adults aged 18 to 39 y with normal blood pressure (<130/85 mm Hg) who do not have other risk factors should be rescreened every 3 to 5 y.
Treatment and Interventions For nonblack patients, initial treatment consists of a thiazide diuretic, calcium-channel blocker, angiotensin-converting enzyme inhibitor, or angiotensin-receptor blocker. For black patients, initial treatment is thiazide or a calcium-channel blocker. Initial or add-on treatment for patients with chronic kidney disease consists of either an angiotensin-converting enzyme inhibitor or an angiotensin-receptor blocker (not both).
Balance of Benefits and Harms The net benefit of screening for high blood pressure in adults is substantial.

For a summary of the evidence systematically reviewed in making this recommendation, the full recommendation statement, and supporting documents, please go to

Current as of: October 2015

Internet Citation: Clinical Summary: High Blood Pressure in Adults: Screening. U.S. Preventive Services Task Force. October 2015.

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