Screening for hypertension annually compared with current practice

Abstract

Purpose: Hypertension is the most common diagnosis in ambulatory care, yet little evidence exists regarding recommended screening intervals or the sensitivity and specificity of a routine office-based blood pressure measurement, the most common screening test. Screening for hypertension is usually performed by measuring blood pressure at every outpatient visit, which often results in transiently elevated findings among adults who do not have a diagnosis of hypertension. We hypothesize that a more limited annual screening strategy may increase specificity while maintaining sensitivity.

Methods: A retrospective case-control study of 372 adults without hypertension and 68 patients with newly diagnosed hypertension was conducted to compare the usual screening practice of checking blood pressure at every visit with a second strategy that considered only annual blood pressure measurements.

Results: Specificity improved from 70.4% (95% CI, 65.5%-75.0%) for the usual practice to 82.0% (95% CI, 77.7%-85.8%) for the annual screening strategy. No statistically significant difference in sensitivity existed between the 2 methods.

Conclusion: A limited annual screening strategy for hypertension can improve specificity without sacrificing sensitivity when compared with routine screening at every visit in previously normotensive adults.

Figure 1

Proposed limited annual screening algorithm for hypertension. BP = blood pressure; CAD = coronary artery disease; CKD = chronic kidney disease; DM = diabetes mellitus; HTN = hypertension.

Figure 2

Case and control selection.