Screening for hypertension

Background
The “Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure” (INC 7)70 recommends medication for hypertension (HTN), defined as blood pressure (BP) ñ140/90 mmHg; medication for prehypertension (defined as BP 120—139/80—89 mmHg) if accompanied by a comorbidity such as chronic kidney disease or diabetes mellitus; and lifestyle changes for prehypertension not accompanied by a comorbidity. The USPSTF recommends blood pressure screening in all individuals aged 18 or older (Grade A—high certainty that the benefits substantially outweigh the harms). The Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report recommends annual blood pressure screening in children aged 3 and older and in younger children with a history of renal, urologic, or cardiac diagnosis or a history of time in the neonatal intensive care unit (ICU). However, the quality and strength of the evidence supporting these recommendations is not provided.

No specific recommendations are made by the USPSTF for individuals with SCD. Individuals with HbSS often have significantly lower diastolic, systolic, and mean BP compared with age/sex-matched healthy controls or individuals with confirmed HbA. Higher baseline systolic pressure was reported to be a risk factor for silent cerebral infarction in a publication subsequent to the original systematic review.

Summary of the Evidence
Thirty-two studies (including 2 RCTs, 14 prospective cohort, 4 retrospective cohort, and 12 cross-sectional studies) involving both adults and children were included and are available in the evidence table.7’’76 Random effects meta-analysis of these 32 studies was conducted to pool the differences in BP between people with SCD and people without SCD. Individuals with HbSS had significantly lower diastolic, systolic, and mean BP compared with age/sex-matched healthy controls or individuals with confirmed normal hemoglobin. However, no studies were found that prognostically defined “normal” or “elevated” BP for people with SCD at any age. The overall quality of evidence to establish baseline BP in persons with SCD, manage elevated BP, or make prognostic associations was low.

However, in studies involving individuals with SCD both with and without HTN defined according to normal population values, HTN was associated with increased mortality and increased risk for stroke in people with SCA. The risk of stroke was also increased for people with SCD even when BP was <140/90.73 For people with SCD, HTN (which had varying definitions in the studies) was associated with increased risk for hospitalization and microalbuminuria. There are no published clinical studies in individuals with SCD demonstrating that treatment of blood pressure to specific target values results in improved outcomes. Thus, in developing consensus recommendations for screening for HTN, the panel adapted recommendations from The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 70 (see http://www.nhlbi.nih.Nov/Ruidclincs/hypcrtcnsion) and the NHLBI report “The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents (see http://www.nhlbi.nih.gov/guidclincs/hypcrtcnsiomhbp ed.htm). Recommendations 1. In adults with SCD, screen for hypertension and treat to lower systolic blood pressure *140 and diastolic blood pressure *90 according to “The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure' (JNC 7). (Consensus—Adapted) 2. In children with SCD, measure blood pressure, and evaluate and treat hypertension following recommendations from the NHLBI's “Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents.’ (Consensus—Adapted)

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