The USPSTF has once again endorsed the importance of screening for HTN with an “A” rating. One of the caveats which will be overlooked is
The USPSTF recommends screening for hypertension in adults 18 years or older with office blood pressure measurement. The USPSTF recommends obtaining blood pressure measurements outside of the clinical setting for diagnostic confirmation before starting treatment.
The language in bold reinforces the critical importance of white coat hypertension and inadequate sampling to establish a diagnosis. Daily variations in BP also make diagnosis more challenging with well described diurnal variations in blood pressure
Two studies raise questions on both the accurate diagnosis of hypertension (HTN) and the need to treat HTN in mild cases in a low risk population
"Benefits and Harms of Antihypertensive Treatment in Low-Risk Patients With Mild Hypertension"
"Comparing Automated Office Blood Pressure Readings With Other Methods of Blood Pressure Measurement for Identifying Patients With Possible Hypertension "
Published in JAMA the articles identify both overdiagnosis and over treatment of millions of individuals currently diagnosed as hypertensive.
The first study did a review of means to measure blood pressure accurately looking at in office manual blood pressure measurement versus automated office based measurement and lastly comparing to ambulatory blood pressure measurement. The results indicated a significant overestimation of measurements due to “white coat” effect The white coat effect is related to measuring BP in the medical setting rather than the at home. Further inaccuracy was questioned due to human rather than machine measurement.
The second study looked at the risk benefit analysis of treating mild HTN in low risk population. They concluded
This prespecified analysis found no evidence to support guideline recommendations that encourage initiation of treatment in patients with low-risk mild hypertension. There was evidence of an increased risk of adverse events, which suggests that physicians should exercise caution when following guidelines that generalize findings from trials conducted in high-risk individuals to those at lower risk.
Patients should be aware of the means of which blood pressure measurements are obtained which frequently overestimate disease and the questionable benefit of treating HTN in a low risk population. Stay tuned , further research is needed. Continuous 24 hour BP devices can be ordered by physicians to assess the extent and nature of BP. In addition automated home devices are inexpensive and very accurate.
If you are being treated for borderline HTN and are low risk it is time to ask your doctor what is the best course of action for you.
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