Physicians' Academy for Cardiovascular Education

More research needed for optimal hypertension screening and confirmatory algorithms

Screening for Hypertension in Adults – Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

Literature - Guirguis-Blake J, Evens CV, Webber EM et al., - JAMA 2021;32(16):1657-1669, doi:10.1001/jama.2020.21669

Introduction and methods

Screening for hypertension using office measurements among adults is standard of care in the US [1], but associated with misclassification of individuals (white coat or masked hypertension). Out-of-office or novel office-based measurement techniques may provide potential benefits.

This systematic review was performed to provide an update of the 2015 US Preventive Service Task Force (USPSTF) recommendations on screening for hypertension in adults [2]. It addressed the benefits and harms of screening, tested accuracy of office-based screening measurements, and methods of confirmatory BP measurements in those with a positive result at screening.

Differences in scope of this update compared to that of the 2015 review were: analysis of specificity and sensitivity of hypertension screening and confirmation, requirement of ambulatory BP measurement as reference standard, inclusion of diabetes patients and no reporting of prognosis associated with various BP measurement modalities.

Eligible studies had to enroll untreated adults or stratify results by treatment status and to be conducted in countries rated as ‘very high’ on the 2015 Human Development Index. 52 Studies were included.

Main results


This study provides an overview of benefits and harms of screening for hypertension in adults, and lists the accuracy of screening and confirmatory BP measurements. The focus was on the accuracy of tests and the harms of screening, as hypertension screening is standard practice and it is not feasible of ethical to study screening in trial setting.

Major accuracy limitations, such as misdiagnosis, were observed with screening using office-based BP measurements. Therefore, there is a need for research to establish algorithms for optimal screening and confirmation of hypertension in clinical practice.


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