Improved hypertension care requires measurement and management in health facilities, not mass screening

Abstract

Improved hypertension control can save millions of lives, but mass hypertension screening, a commonly used approach, is a barrier to progress. Although politically appealing, mass screening diverts resources from improving services in primary health care. Hypertension treatment requires ongoing, long-term care. Mass screening is inefficient: many people with hypertension are not screened or not screened accurately; most people referred do not follow up; many who do follow up are found not to have hypertension; and among those who have hypertension, few initiate and adhere to treatment. Universal measurement of blood pressure among all adults attending health facilities is much more effective and facilitates treatment and ongoing care. Universal facility-based screening can improve diagnosis and control substantially, including among underserved populations. Implementing this approach requires that facilities have validated blood pressure monitors, routinely screen at least all patients aged 30 years and older, and increase the number and proportion of patients being treated for hypertension whose blood pressure is at target (eg, <140/90 mm Hg). The only way to control hypertension is to strengthen facility-based detection and treatment. To prevent heart attacks, strokes, death, and other complications of untreated and inadequately treated hypertension, countries should track and steadily increase the outcome that matters: the number of patients on treatment whose blood pressure is controlled.