Screening For Hypertension Annually Compared With Current Practice

Gregory M. Garrison; Sara Oberhelman

doi:10.1370/afm.1467

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Screening for Hypertension Annually may not capture as many hypertensive patients
Robert C Dickson

Published on: 25 March 2013

Published on: (25 March 2013)
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Screening for Hypertension Annually may not capture as many hypertensive patients
Robert C Dickson, Physician
This paper raises several interesting issues and suggests a novel approach to screening for hypertensive patients. We addressed some of the same issues in our paper "Self-Reported Physician Adherence to Guidelines for Measuring Blood Pressure", published in the March/April 2013 issue of the Journal of the American Board of Family Medicine (JABFM 2013;26:215-217). I agree that it is not practical to adhere to the "Guidelin...
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This paper raises several interesting issues and suggests a novel approach to screening for hypertensive patients. We addressed some of the same issues in our paper "Self-Reported Physician Adherence to Guidelines for Measuring Blood Pressure", published in the March/April 2013 issue of the Journal of the American Board of Family Medicine (JABFM 2013;26:215-217). I agree that it is not practical to adhere to the "Guidelines", either US or Canadian, suggested for accurate blood pressure measurement. Time constraints and physical attributes of some offices do not allow for adherence to the "ideal".
Measurement of blood pressure in patients who present with unrelated, episodic problems should be no more stressful than a measurement performed in a structured fashion "once a year". Many patients might not attend for "preventive maintenance" and hence would be missed if not checked incidentally. The authors do admit that annual screening missed 7.4% of hypertensive patients - compared to none in the "every visit" cohort. Morbidity arising from hypertension which is not diagnosed can be substantial.
I have seen wide variations in blood pressure, measured as carefully as possible, in certain patients who present with acute or incidental problems. Whatever the reason for this variation, it need not initiate extensive investigation. Watchful waiting and repeat measurement often provides an "average" blood pressure in these individuals.This would not be the case if blood pressure were measured once a year - assuming that every patient in a practice did attend yearly when asymptomatic and that at that point, their blood pressure was measured "accurately".
Competing interests: None declared
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Competing Interests: None declared.