title: Diagnostic and predictive accuracy of blood pressure screening methods with consideration of rescreening intervals: a systematic review for the U.S. Preventive Services Task Force.
abstract: BACKGROUND
  Elevated blood pressure (BP) is the largest contributing risk factor to all-cause and cardiovascular mortality.
  
  
  OBJECTIVE
  To update a systematic review on the benefits and harms of screening for high BP in adults and to summarize evidence on rescreening intervals and diagnostic and predictive accuracy of different BP methods for cardiovascular events.
  
  
  METHODS
  Selected databases searched through 24 February 2014.
  
  
  METHODS
  Fair- and good-quality trials and diagnostic accuracy and cohort studies conducted in adults and published in English.
  
  
  METHODS
  One investigator abstracted data, and a second checked for accuracy. Study quality was dual-reviewed.
  
  
  RESULTS
  Ambulatory BP monitoring (ABPM) predicted long-term cardiovascular outcomes independently of office BP (hazard ratio range, 1.28 to 1.40, in 11 studies). Across 27 studies, 35% to 95% of persons with an elevated BP at screening remained hypertensive after nonoffice confirmatory testing. Cardiovascular outcomes in persons who were normotensive after confirmatory testing (isolated clinic hypertension) were similar to outcomes in those who were normotensive at screening. In 40 studies, hypertension incidence after rescreening varied considerably at each yearly interval up to 6 years. Intrastudy comparisons showed at least 2-fold higher incidence in older adults, those with high-normal BP, overweight and obese persons, and African Americans.
  
  
  CONCLUSIONS
  Few diagnostic accuracy studies of office BP methods and protocols in untreated adults.
  
  
  CONCLUSIONS
  Evidence supports ABPM as the reference standard for confirming elevated office BP screening results to avoid misdiagnosis and overtreatment of persons with isolated clinic hypertension. Persons with BP in the high-normal range, older persons, those with an above-normal body mass index, and African Americans are at higher risk for hypertension on rescreening within 6 years than are persons without these risk factors.
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Piper
authors.forename: Corinne V
authors.initials: CV
authors.lastname: Evans
authors.forename: Brittany U
authors.initials: BU
authors.lastname: Burda
authors.forename: Karen L
authors.initials: KL
authors.lastname: Margolis
authors.forename: Elizabeth
authors.initials: E
authors.lastname: O'Connor
authors.forename: Evelyn P
authors.initials: EP
authors.lastname: Whitlock
mesh_terms: D001795:Blood Pressure Determination / Q000592:standards*; D018660:Blood Pressure Monitoring, Ambulatory / Q000592:standards*; D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control; D003951:Diagnostic Errors; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D015994:Incidence; D008403:Mass Screening / Q000009:adverse effects / Q000379:methods* / Q000592:standards*; D012015:Reference Standards; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D019564:Unnecessary Procedures; D059466:White Coat Hypertension / Q000175:diagnosis / Q000453:epidemiology