Hypertension Screening in Adults

Overview

• Document by the Canadian Task Force on Preventive Health Care (CTFPHC) from 2012.
• Focuses on screening for hypertension in adults aged 18 and older.
• Recommendations are for primary care visits.

Recommendations for Screening

• All adults 18+ should be screened at appropriate primary care visits:
  • New patient visits
  • Periodic health exams
  • Urgent visits related to neurological/cardiovascular issues
  • Medication renewals
  • Other deemed suitable visits by the practitioner
• Not necessary to measure blood pressure at every visit if not clinically indicated.

Specific Recommendations

1. Measure blood pressure at all applicable primary care visits.
2. Use Canadian Hypertension Education Program (CHEP) techniques for accurate measurements.
3. Apply CHEP criteria to determine diagnosis if elevated blood pressure is found during screening.

Implementation Considerations

• Use electronic health records to flag reminders for screening, especially for those not recently screened.

Special Considerations

• Frequency of screening may vary:
  • Increases with age, comorbidities, other risk factors.
  • High-risk ethnic groups may need more frequent monitoring.
  • Consistent normal results may reduce need for frequent monitoring.

Follow-Up and Diagnosis

• Initial measurement followed by scheduled follow-ups if indicated:
  • Visit 1: History, physical exam, and diagnostic tests if needed.
  • Visit 2 & 3: Follow-up within one month if elevated SBP/DBP.
  • Diagnosis of Hypertension (HTN): If elevated measures are consistent across visits.

Hypertensive Urgencies and Emergencies

• Conditions include hypertensive encephalopathy, acute aortic dissection, etc.

Diagnostic Tests

• Urinalysis, blood chemistry, fasting glucose and cholesterol, ECG, urinary albumin in diabetics.

Target Organ Damage

• Examples: Stroke, dementia, retinopathy, coronary artery disease.

Measurement Techniques

• Use validated devices for multiple readings to get averages.
• ABPM: Ambulatory Blood Pressure Measurement.
• HBPM: Home Blood Pressure Measurement.

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This guideline emphasizes the importance of screening for hypertension during appropriate adult healthcare visits and provides detailed recommendations for follow-up and diagnosis.