Table 3 Key question 1, 1A, 1B eligibility criteria, from USPSTF 2021 review (KQ1: What are the benefits and harms of screening for hypertension in adults? KQ1a: How do the benefits and harms vary by (a) screening interval and (b) age at screening? KQ1b: What is the cumulative incidence of hypertension (a) over different screening intervals and/or (b) at different ages?)

Aim

Screening for hypertension in a primary care setting

Studies measuring blood pressure for reasons other than screening or confirmation of a hypertension diagnosis; mathematical transformation of blood pressure results (e.g., pulse pressure, variability) or diurnal variations (e.g., morning surge, dipping) for use as additional diagnostic criteria, predicting risk, or both

Population

Adults age ≥ 18 years

Pregnant women, children (age < 18 years), inpatients, persons in institutions, patients with secondary hypertension, and highly selected groups of patients (e.g., those with chronic kidney disease or renal transplant) who do not represent a primary screening population

Patients treated for hypertension with medication

Interventions

Benefits & harms:

Clinic-based, noninvasive brachial blood pressure measurement (manual or attended/unattended automated) using any common device or screening protocol during a single encounter

Harms:

HBPM and ABPM

Benefits & harms:

Blood pressure measurement with wrist and finger monitors, forearm cuffs, or ankle and toe measures; any method not commonly used in routine blood pressure screening (e.g., invasive methods, noninvasive method of central blood pressure measurement); Osler’s maneuver

Benefits:

HBPM and ABPM

Comparator

No blood pressure measurement with the intention of screening

Outcomes

Potential benefits of the following:

1. Reduced all-cause mortality

2. Reduced CVD-related mortality

3. Reduced macrovascular CVD events (cardiovascular disease events, including myocardial infarction, sudden cardiac death, stroke, heart failure, and hospitalization for coronary heart disease, symptomatic peripheral arterial disease)

4. Reduced microvascular CVD events (end-stage renal disease, vascular dementia)

Potential harms:

5. Increased harms of screening (e.g., labeling, absenteeism, quality of life measures, tolerability of ABPM devices)

6. Increased overdiagnosis^a

Potential benefits or harms:

7. Increased/decreased quality of life

Cardiovascular symptoms (e.g., palpitations), angina pectoris (chest pain), revascularization, carotid intima-media thickness, left ventricular hypertrophy, or patient satisfaction

Timing of outcome assessment

No restrictions

No restrictions

Setting

Eligible primary care settings must have physicians or personnel trained in blood pressure measurement, established blood pressure measurement protocols, and ongoing documentation procedures

Settings not generalizable to primary care, inpatient/residential facilities

Study design

Benefits:

Randomized controlled trials (RCTs) CTs and controlled clinical trials (CCTs)

Harms:

RCTs, CCTs, and cohort studies

Benefits & harms:

Before-after studies, time series, case series, case reports, case–control studies, and simulation studies

Harms:

Cross-sectional studies

Country

Studies conducted in countries categorized as “very high” on the 2015 Human Development Index (as defined by the United Nations Development Programme)

Studies conducted in countries not categorized as

“very high” on the 2015 Human Development Index

Language

English^b

N/A

Study quality

Fair or good quality^b

N/A