Will the 2021 USPSTF Hypertension Screening Recommendation Decrease or Worsen Racial/Ethnic Disparities in Blood Pressure Control?

Abstract

Hypertension, defined as systolic blood pressure (BP) greater than or equal to 130 mm Hg or diastolic BP greater than or equal to 80 mm Hg, or currently using medication to lower BP, is a potent cardiovascular disease (CVD) risk factor affecting 45.4% of the adult US population. 1 The highest prevalence is among non-Hispanic/Latinx Black adults (57.1%), for whom earlier age of onset and treatment resistance confer greater hypertension-related CVD, including coronary artery disease, congestive heart failure, cerebrovascular accident, and end-stage renal disease. Although the overall Author affiliations and article information are listed at the end of this article.

Home Blood Pressure Monitoring for Hypertension Diagnosis by Current Recommendations: A Long Way to Go

“…Although we did not observe statistically significant differences by race/ethnicity or other patient characteristics, health systems should ensure that implementation plans are equitable and close rather than widen racial/ethnic and geographic hypertension disparities. 5 These findings are limited in that National Health and Nutrition Examination Survey had office BP from a single visit and were collected before recent screening recommendations; thus, our analyses do not reflect the impact of these guidelines on clinician or patient uptake of HBPM for hypertension diagnosis. Additionally, the impact of the COVID-19 The figure shows US adults (age ≥20 y) from the NHANES 2009-2014 cycles without diagnosed hypertension, not using antihypertensive medications, and an office blood pressure (BP) ≥130/80 mm Hg (n=7185).…”

“… 4 Further, barriers relevant to the accessibility and affordability of out-of-office BP monitoring have led to concerns that there may be disparities in the uptake of hypertension screening recommendations. 5 This analysis examined how historical use of HBPM aligns with current out-of-office BP monitoring recommendations for hypertensive US adults without a previous hypertension diagnosis, and how HBPM use varies by patient characteristics.…”

Effect of Lifestyle Coaching or Enhanced Pharmacotherapy on Blood Pressure Control Among Black Adults With Persistent Uncontrolled Hypertension

“…Owing to the pragmatic design, assessment of BP during the 12-month follow-up may have been inadequate. Future pragmatic studies on hypertension should consider the use of home-based BP monitoring to increase the number of data points . In addition, the participants could have needed more time to implement their learnings.…”

Improving Behavioral Counseling for Primary Cardiovascular Disease Prevention

“…Unfortunately, despite prior USPSTF recommendations, as a society, the US remains stubbornly deficient in decreasing and eventually eliminating racial/ethnic disparities in CVD outcomes and implementing the appropriate multilevel approaches. 16 The future health of the US population is dependent on these efforts.…”

“…Along with counseling, structural changes in health care and tailored community-based interventions are reasonable approaches to halt or reverse significant disparities in morbidity and mortality within certain population subsets. Unfortunately, despite prior USPSTF recommendations, as a society, the US remains stubbornly deficient in decreasing and eventually eliminating racial/ethnic disparities in CVD outcomes and implementing the appropriate multilevel approaches . The future health of the US population is dependent on these efforts.…”