Measure Components	The CDU uses a standard process/protocol for properly screening all adults ≥18 years of age for HBP (based on an average of ≥2 BP measurements), including:
	1. Adults ages 18–39 y with office-measured SBP/DBP <120/80 mm Hg who do not have other hypertension risk factors can space out screenings to every 3–5 y (USPSTF).15
	2. Annual BP screening should be done for adults at increased risk for hypertension, defined as those ≥40 y of age and those <40 y of age who are overweight or obese or black, regardless of age.
	3. For adults, the finding of an office BP consistent with hypertension and with SBP/DBP <160/100 mm Hg at an initial visit should be confirmed at a follow-up visit within 1 month, based on an average of ≥2 BP measurements at each visit.
	4. 2017 Hypertension Clinical Practice Guidelines Recommendation4: In adults with an untreated SBP >130 mm Hg but <160 mm Hg or DBP >80 mm Hg but <100 mm Hg, it is reasonable to screen for the presence of white-coat hypertension by using either daytime ABPM or HBPM before diagnosis of hypertension.61–68 (Class 2a, Level of Evidence: B-NR)
	5. 2017 Hypertension Clinical Practice Guidelines Recommendation4: In adults with untreated office BPs that are consistently between 120 mm Hg and 129 mm Hg for SBP or between 75 mm Hg and 79 mm Hg for DBP, screening for masked hypertension with HBPM (or ABPM) is reasonable.61,62,65,67,161 (Class 2a, Level of Evidence: B-NR)
Rationale
The evidence for the benefits of screening for HBP is well established. In 2007, the USPSTF reaffirmed its 2003 recommendation to screen for hypertension in adults ≥18 y of age (Grade A recommendation). Previous evidence reviews commissioned by the USPSTF found good-quality evidence that screening for hypertension has few major harms and provides substantial benefits.162,163 However, these reviews did not address the diagnostic accuracy of different BP measurement protocols or identify a reference standard for measurement confirmation. For the present recommendation, the USPSTF examined the diagnostic accuracy of office BP measurement, ABPM, and HBPM. The USPSTF also assessed the accuracy of these BP measurements and methods in confirming the diagnosis of hypertension. In addition, it reviewed data on optimal screening intervals for diagnosing hypertension in adults.
The USPSTF found good evidence that screening for and treatment of HBP has few major harms. The USPSTF concluded with high certainty that the net benefit of screening for HBP in adults is substantial.15 No clinical trials randomly assigned patients to different rescreening intervals and evaluated clinical outcomes. Many observational studies have followed patients over time to determine how many develop hypertension at intervals of 1 to 5 y.15,164
Clinical Recommendations
USPSTF Final Recommendation Statement on HBP in Adults15
1. The USPSTF recommends screening for HBP in adults aged 18 y or older. The USPSTF recommends obtaining measurements outside of the clinical setting for diagnostic confirmation before starting treatment.164 (USPSTF, Grade A)

ABPM indicates ambulatory blood pressure monitoring; BP, blood pressure; CDU, care delivery unit; DBP, diastolic blood pressure; HBP, high blood pressure; HBPM, home blood pressure monitoring; SBP, systolic blood pressure; and USPSTF, US Preventive Services Task Force.