{"id":10832,"date":"2025-11-17T16:56:47","date_gmt":"2025-11-18T00:56:47","guid":{"rendered":"https:\/\/www.telemedical.com\/wordpress\/?page_id=10832"},"modified":"2025-11-17T16:56:54","modified_gmt":"2025-11-18T00:56:54","slug":"screening-for-hypertension","status":"publish","type":"page","link":"https:\/\/www.telemedical.com\/wordpress\/screening-for-hypertension\/","title":{"rendered":"Screening for Hypertension"},"content":{"rendered":"\n<pre class=\"wp-block-preformatted\"> \nRecommendation:\n \nBlood pressure should be measured regularly in all persons \naged 3 and above (see Clinical Intervention).\n \nBurden of Suffering\n \nHypertension may occur in as many as 58 million Americans.\n\nIt is a leading risk factor for coronary artery disease, \ncongestive heart failure, stroke, renal disease, and \nretinopathy. These complications of hypertension are among \nthe most common and serious diseases in the United States, \nand successful efforts to lower blood pressure could thus \nhave substantial impact on population morbidity and \nmortality. Heart disease is the leading cause of death in \nthe United States, accounting for over 765,000 deaths each \nyear, and cerebrovascular disease, the third leading cause \nof death, accounts for 150,000 deaths each year.\n\nHypertension is more common in blacks and the elderly.\n \nEfficacy of Screening Tests\n \nThe most accurate devices for measuring blood pressure \n(e.g., intraarterial catheters) are not appropriate for \nroutine screening because of their invasiveness, technical \nlimitations, and cost. Office sphygmomanometry (the blood \npressure cuff) remains the most appropriate screening test \nfor hypertension in the asymptomatic population. Although \nthis test is highly accurate when performed correctly, \nfalse-positive and false-negative results (i.e., recording \na blood pressure that is not representative of the \npatient's mean blood pressure) do occur in clinical \npractice.3 A recent study found that 21% of persons \ndiagnosed as mildly hypertensive based on office \nsphygmomanometry had no evidence of hypertension when \n24-hour ambulatory recordings were obtained.\n \nErrors in measuring blood pressure may result from \ninstrument, observer, and\/or patient factors.5 Examples of \ninstrument error include manometer dysfunction, pressure \nleaks, stethoscope defects, and bladders of incorrect width \nand length for the patient's arm size. The observer can \nintroduce errors due to sensory impairment (difficulty \nhearing Korotkoff sounds or reading the manometer), \ninattention, inconsistency in recording Korotkoff sounds \n(e.g., Phase IV vs. Phase V), and subconscious bias (e.g., \ndigit preference'' for numbers ending with zero or \npreconceived notions of normal'' pressures). The patient \ncan be the source of misleading readings due to posture and \nbiological factors. Posture (i.e., lying, standing, \nsitting) and arm position in relation to the heart can \naffect results by as much as 10 mm Hg.5 Biological factors \ninclude anxiety, meals, tobacco, temperature changes, \nexertion, and pain. Due to these limitations in the \ntest-retest reliability of blood pressure measurement, it \nis commonly recommended that hypertension be diagnosed only \nafter more than one elevated reading is obtained on each of \nthree separate visits.\n \nAdditional factors affect accuracy when performing \nsphygmomanometry on children; these difficulties are \nespecially common when testing infants and toddlers under \nage 3.6 First, there is increased variation in arm \ncircumference, requiring greater care in the selection of \ncuff sizes. Second, the examination is more frequently \ncomplicated by the anxiety and restlessness of the patient. \nThird, the disappearance of Korotkoff sounds (Phase V) is \noften difficult to hear in children and Phase IV values are \noften substituted. Fourth, erroneous Korotkoff sounds can \nbe produced inadvertently by the pressure of the \nstethoscope diaphragm against the antecubital fossa. \nFinally, the definition of pediatric hypertension has \nitself been uncertain because of confusion over normal \nvalues during childhood. Previous criteria using population \ndata to define the 95th percentile at different ages were \nerroneously high.7 Revised criteria for pediatric \nhypertension, based on data from over 70,000 children, have \nrecently been published6 (see Clinical Intervention).\n \nEffectiveness of Early Detection\n \nThere is a direct relationship between the magnitude of \nblood pressure elevation and the benefit of lowering \npressure. In persons with malignant hypertension, the \nbenefits of intervention are most dramatic; treatment \nincreases five-year survival from near zero (data from \nhistorical controls) to 75%.8 The efficacy of treating \nmoderate hypertension (diastolic blood pressure above 104 \nmm Hg) is also clear, as demonstrated in the Veterans \nAdministration Cooperative Study on Antihypertensive \nAgents.9-11 In this randomized double-blind controlled \ntrial, middle-aged men with diastolic blood pressure above \n104 mm Hg experienced a significant reduction in \ncardiovascular events after treatment with antihypertensive \nmedication. \n\nPersons with mild hypertension (diastolic blood pressure of \n90-104 mm Hg) also benefit from treatment. This was \nconfirmed in the Hypertension Detection and Follow-Up \nProgram, a randomized controlled trial involving nearly \n11,000 hypertensives.12 The intervention group received \nstandardized pharmacologic treatment (stepped care'') while \nthe control group was referred for community medical care. \nThere was a statistically significant 17% reduction in \nfive-year all-cause mortality in the group receiving \nstandardized drug therapy; the subset with mild \nhypertension experienced a 20% reduction in mortality.12 \nDeaths due to cerebrovascular disease, ischemic heart \ndisease, and other causes were also significantly reduced \nin the stepped care group.13 Similar results have been \nreported in other studies, such as the Australian National \nBlood Pressure Study14 and the Medical Research Council \ntrial.15 Although treatment of hypertension is associated \nwith multiple benefits, the greatest effect appears to be \nin the prevention of cerebrovascular disease.16 Improved \ntreatment of high blood pressure has been credited with the \ngreater than 50% reduction in age-adjusted stroke mortality \nthat has been observed since 1972.\n \nAlthough the efficacy of antihypertensive treatment has \nbeen well established in clinical research, certain factors \nmay influence the magnitude of benefit achieved in actual \npractice. First, the benefits of treatment may be less \nsignificant or less well proven in certain population \ngroups, such as children. Second, nonpharmacologic \nfirst-line therapy (e.g., weight reduction, exercise, \nsodium restriction, decreased alcohol intake) may be less \neffective than drug therapy in achieving significant and \nconsistent blood pressure reductions. Although it is known \nthat weight reduction and sodium restriction can lower \nblood pressure,18,19 the magnitude and duration of \nreduction in actual practice may be limited by biological \nfactors (e.g., hypertensives who are not salt-sensitive'') \nand the difficulties of maintaining behavioral changes \n(e.g., weight loss). Finally, compliance with drug therapy \nmay be limited by the inconvenience, side effects, and cost \nof these agents.\n \nRecommendations of Others\n \nRevised recommendations for adults from the National Heart, \nLung, and Blood Institute were issued recently by the Joint \nNational Committee on Detection, Evaluation, and Treatment \nof High Blood Pressure,1 and similar recommendations have \nbeen issued by the American Heart Association.22 These call \nfor routine blood pressure measurement at least once every \ntwo years for persons with a diastolic blood pressure below \n85 mm Hg and a systolic pressure below 140 mm Hg. \nMeasurements are recommended annually for persons with a \ndiastolic blood pressure of 85-89 mm Hg. Persons with \nhigher blood pressures require more frequent measurements. \nThe Canadian Task Force recommends that all persons aged 25 \nand over receive a blood pressure measurement during any \nvisit to a physician.23 The American Academy of Pediatrics \nand the National Heart, Lung, and Blood Institute recommend \nthat children and adolescents receive annual blood pressure \nmeasurements from ages 3-20.6\n \nDiscussion\n \nIt is clear from several large clinical trials that \nlowering blood pressure is beneficial and that the \npopulation incidence of several leading causes of death can \nbe reduced through the detection and treatment of high \nblood pressure. An average diastolic blood pressure \nreduction of 6-8 mm Hg across the population could reduce \nthe incidence of coronary artery disease by 25% and the \nincidence of strokes by 50%.24 At the same time, it is \nimportant for clinicians to minimize the potential harmful \neffects of detection and treatment. For example, if \nperformed incorrectly, sphygmomanometry can produce \nmisleading results. Some hypertensive patients thereby \nescape detection (false negatives) and some normotensive \npersons receive inappropriate labeling (false positives), \nwhich may have certain psychological, behavioral, and even \nfinancial consequences.25 Treatment of hypertension can \nalso be harmful as a result of medical complications, \nespecially related to drugs. Clinicians can minimize these \neffects by using proper technique when performing \nsphygmomanometry, making appropriate use of \nnonpharmacologic methods, and prescribing antihypertensive \ndrugs with careful adherence to current guidelines.\n \nClinical Intervention\n \nBlood pressure should be measured regularly in all persons \naged 3 and above. The optimal interval for blood pressure \nscreening has not been determined and is left to clinical \ndiscretion. Current expert opinion is that persons thought \nto be normotensive should receive blood pressure \nmeasurements at least once every two years if their last \ndiastolic and systolic blood pressure readings were below \n85 mm Hg and 140 mm Hg, respectively, and annually if the \nlast diastolic blood pressure was 85-89 mm Hg.1 \nSphygmomanometry should be performed in accordance with \nrecommended technique.*1 Hypertension should not be \ndiagnosed on the basis of a single measurement; elevated \nreadings** should be confirmed on more than one reading at \neach of three separate visits. Once confirmed, patients \nshould receive counseling regarding exercise (see Chapter \n49), weight reduction, dietary sodium intake (Chapter 50), \nand alcohol consumption (Chapter 47).1 Other cardiovascular \nrisk factors, such as smoking and elevated serum \ncholesterol, should also be discussed (Chapters 2 and 48). \nAntihypertensive drugs should be prescribed in accordance \nwith recent guidelines1 and with attention to current \ntechniques for improving compliance.\n \nNotes\n \n*Guidelines for Sphygmomanometry\n \n  Patient should be seated with arm bared, supported, and \npositioned at heart level.\n \n  Patient should have refrained from smoking or ingesting \ncaffeine within 30 minutes before measurement.\n \n  Measurement should begin after five minutes of quiet \nrest.\n \n  An appropriate cuff size (child, adult, large adult) \nshould be selected; the rubber bladder should encircle at \nleast two thirds of the arm.\n \n  Measurements should be taken with a mercury \nsphygmomanometer, a recently calibrated aneroid manometer, \nor a validated electronic device.\n \n  Both systolic and diastolic pressures should be recorded; \nthe disappearance of sound (Phase V) indicates the \ndiastolic pressure.\n \n  Two or more readings should be averaged; if the first two \ndiffer by more than 5 mm Hg, additional readings should be \nobtained.\n \n\n**In adults, current blood pressure criteria for the \ndiagnosis are a diastolic pressure of 90 mm Hg or greater \nor a systolic pressure of 140 mm Hg or greater.1()  In \nchildren, the criteria vary with age:6\n \nPediatric Blood Pressure\n \nAge (Yrs)  Diastolic (mm Hg)  Systolic (mm Hg)\n \n0-2    \t   74\t\t    \t   112\n 3-5    \t   76\t\t    \t   116\n 6-9    \t   78\t\t    \t   122\n 10-12  \t   82\t\t    \t   126\n 13-15  \t   86\t\t    \t   136\n \nReferences\n \n1.\n \n1988 Joint National Committee. The 1988 report of the Joint \nNational Committee on Detection, Evaluation, and Treatment \nof High Blood Pressure. Arch Intern Med 1988; 148:1023-38.\n \n2. National Center for Health Statistics. Advance report of \nfinal mortality statistics, 1986. Monthly Vital Statistics \nReport [Suppl], vol. 37, no. 6. Hyattsville, Md.: Public \nHealth Service, 1988. (Publication no. DHHS (PHS) \n88-1120.)\n \n3.\n \nTifft CP. Are the days of the sphygmomanometer past? Arch \nIntern Med 1988; 148:518-9.\n \n4.\n \nPickering TG, James GD, Boddie C, et al. How common is \nwhite coat hypertension? JAMA 1988; 259:225-8.\n \n5.\n \nKirkendall WM, Feinleib M, Freis ED, et al. Recommendations \nfor human blood pressure determination by \nsphygmomanometers. Subcommittee of the AHA Postgraduate \nEducation Committee. Circulation 1980; 62:1146A-55A.\n \n6.\n \nTask Force on Blood Pressure Control in Children. Report of \nthe Second Task Force on Blood Pressure Control in \nChildren--1987. Pediatrics 1987; 79:1-25.\n \n7.\n \nMehta SK. Pediatric hypertension: a challenge for \npediatricians. Am J Dis Child 1987; 141:893-4.\n \n8.\n \nHansson L. Current and future strategies in the treatment \nof hypertension. Am J Cardiol 1988; 61:2C-7C.\n \n9.\n \nVeterans Administration Cooperative Study Group on \nAntihypertensive Agents. Effects of treatment on morbidity \nin hypertension. III. Influence of age, diastolic pressure, \nand prior cardiovascular disease: further analysis of side \neffects. Circulation 1972; 45:991-1004.\n \n10.\n \nIdem. Effects of treatment on morbidity in hypertension: \nresults in patients with diastolic pressures averaging 115 \nthrough 129 mm Hg. JAMA 1967; 202:1028-34.\n \n11.\n \nIdem. Effects of treatment on morbidity in hypertension. \nII. Results in patients with diastolic pressures averaging \n90 through 114 mm Hg. JAMA 1970; 213:1143-52. 12.\n \nHypertension Detection and Follow-Up Program Cooperative \nGroup. Five-year findings of the Hypertension Detection and \nFollow-Up Program. I. Reduction in mortality of persons \nwith high blood pressure, including mild hypertension. JAMA \n1979; 242:Idem. Persistence of reduction in blood pressure \nand mortality of participants in the Hypertension Detection \nand Follow-Up Program. JAMA 1988; 259:2113-22.\n \n14.\n \nManagement Committee of the Australian National Blood \nPressure Study. The Australian therapeutic trial in mild \nhypertension. Lancet 1980; 1:1261-7.\n \n15.\n \nMedical Research Council Working Party. MRC trial of \ntreatment of mild hypertension: principal results. Br Med J \n1985; 291:97-104.\n \n16.\n \nMacMahon SW, Cutler JA, Furberg CD, et al. The effects of \ndrug treatment for hypertension on morbidity and mortality \nfrom cardiovascular disease: a review of randomized, \ncontrolled trials. Prog Cardiovasc Dis [Suppl] 1986; \n29:99-118. and the declining incidence of stroke. JAMA \n1987; 258:214-7.\n \n17.\n \nGarraway WM, Whisnant JP. The changing pattern of \nhypertension and the declining incidence of stroke. JAMA \n1987; 258:214-7.\n \n18.\n \nNonpharmacological approaches to the control of high blood \npressure. Final report of the Subcommittee on \nNonpharmacological Therapy of the 1984 Joint National \nCommittee on Detection, Evaluation, and Treatment of High \nBlood Pressure. Hypertension 1986; 8:444-67.\n \n19.\n \nStamler J, Stamler R. Intervention for the prevention and \ncontrol of hypertension and atherosclerotic diseases: \nUnited States and international experience. Am J Med 1984; \n76:13-36.\n \n20.\n \nMcClellan WM, Hall WD, Brogan D, et al. Continuity of care \nin hypertension: an important correlate of blood pressure \ncontrol among aware hypertensives. Arch Intern Med 1988; \n148:525-8.\n \n21.\n \nNational Institutes of Health. The physician's guide: \nimproving adherence among hypertensive patients. Working \nGroup on Health Education and High Blood Pressure Control. \nBethesda, Md.: Department of Health and Human Services, \n1987.\n \n22.\n \nGrundy SM, Greenland P, Herd A, et al. Cardiovascular and \nrisk factor evaluation of healthy American adults. A \nstatement for physicians by an ad hoc committee appointed \nby the Steering Committee, American Heart Association. \nCirculation 1987; 75:1340A-62A.\n \n23.\n \nCanadian Task Force on the Periodic Health Examination. \n1984 update. Can Med Assoc J 1984; 130:2-15.\n \n24.\n \nBlackburn H. Public policy and dietary recommendations to \nreduce the population level of blood cholesterol. Am J Prev \nMed 1985; 1:3-11.\n \n25.\n \nMacDonald LA, Sackett DL, Haynes RB, et al. Labelling in \nhypertension: a review of the behavioral and psychological \nconsequences. J Chron Dis 1984; 37:933-42.\n \n\n\n.<\/pre>\n","protected":false},"excerpt":{"rendered":"<p>Recommendation: Blood pressure should be measured regularly in all persons aged 3 and above (see Clinical Intervention). Burden of Suffering Hypertension may occur in as many as 58 million Americans. It is a leading risk factor for coronary artery disease, congestive heart failure, stroke, renal disease, and retinopathy. These complications of hypertension are among the [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-10832","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.telemedical.com\/wordpress\/wp-json\/wp\/v2\/pages\/10832","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.telemedical.com\/wordpress\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.telemedical.com\/wordpress\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.telemedical.com\/wordpress\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.telemedical.com\/wordpress\/wp-json\/wp\/v2\/comments?post=10832"}],"version-history":[{"count":1,"href":"https:\/\/www.telemedical.com\/wordpress\/wp-json\/wp\/v2\/pages\/10832\/revisions"}],"predecessor-version":[{"id":10833,"href":"https:\/\/www.telemedical.com\/wordpress\/wp-json\/wp\/v2\/pages\/10832\/revisions\/10833"}],"wp:attachment":[{"href":"https:\/\/www.telemedical.com\/wordpress\/wp-json\/wp\/v2\/media?parent=10832"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}