Priority Topic: Hypertension

Key Feature 1: Screen for hypertension.
Skill: Clinical Reasoning
Phase: Hypothesis generation, Physical

Key Feature 2: Use correct technique and equipment to measure blood pressure.
Skill: Psychomotor Skills/Procedure Skills
Phase: Physical

Key Feature 3: Make the diagnosis of hypertension only after multiple BP readings (i.e., at different times and during different visits).
Skill: Clinical Reasoning
​Phase: Diagnosis

Screening for hypertension, like all screening maneuvers, is recommended to happen at varying time intervals, depending on what guideline you look at. Overall, it is one of the screening maneuvers that actually has a bit more consensus across guidelines, and it tends to be recommended annually in adults. (Although I will point out that the evidence behind this recommendation is not very strong. The Hypertension Canada guideline lists the evidence to support this recommendation as Grade D.) To make my life simple as I train to be a Canadian Family Medicine graduate, I choose to follow the recommendations of the Canadian Task Force on Preventative Health Care to guide my approach to screening in primary care, as these are regional but also national recommendations. Once in practice, in the province where I know I will be living and working after graduation, I may choose to instead follow provincial college guidelines, as these may better account for more local considerations. The CTFPHC guideline on hypertension makes the following 3 recommendations:

1. We recommend blood pressure measurement at all appropriate primary care visits 
2. We recommend that blood pressure be measured according to the current techniques described in the Canadian Hypertension Education Program CHEP recommendations for office and out-of-office (ambulatory) blood pressure measurement.
3. For people who are found to have an elevated blood pressure during screening, the CHEP criteria for assessment and diagnosis of hypertension should be applied to determine whether the patient meets diagnostic criteria for hypertension.

The rest of the information discussed in this post will be informed by the Hypertension Canada Guideline.

The options to capture blood pressure measurements are as follows. Automated office blood pressure is the preferred method of performing in-office BP measurement, and electronic upper arm devices are preferred over auscultation. 

1. Automated office blood pressure (AOBP)
2. Non-automated office blood pressure (non-AOBP)
3. Home blood pressure monitoring
4. Ambulatory blood pressure monitoring

The tables shown below outline proper technique using the above 4 types of BP measurement according to Hypertension Canada:

The following figure demonstrates an approach to screening for hypertension: