Non-physician screening and self-screening can detect raised blood pressure

Fleming S, Atherton H, McCartney D, et al. Self-screening and non-physician screening for hypertension in communities: A systematic review Am J Hypertens. 2015; 28: 1316-24.

Review question

Can non-physician screening and self-screening methods improve the detection of high blood pressure (hypertension) for adults living in the community?

Background

High blood pressure (hypertension) is a preventable condition. Identifying and treating people with high blood pressure reduces the risk of stroke and heart disease. This condition is commonly detected through routine physician screening and individuals who do not regularly visit a doctor or access other primary health care services may not be screened. The aim of the study is to measure whether other methods (non-physician screening and self-screening) may improve the detection of high blood pressure.

How the review was done

This is a systematic review of 73 studies that included community-based screening methods by non-physicians (nurses, medical students, dentists, pharmacists, and lay people) or self-screening for high blood pressure.

Key features of the studies were:

• Participants were over 18 years of age
• All were published between 1980 and 2013
• 49 of the 73 studies were conducted in North America and most screening took place in pharmacies, public areas, community buildings, and mobile units
• Majority of screeners were nurses and lay screeners; only 2 studies evaluated self-screening
• Researchers measured the effectiveness of each blood pressure screening method, including rates of people screened, detection of raised blood pressure among those screened, and rates of follow up (eg. new diagnoses).  
• They also looked at whether the setting, people doing the screening, and the target population affected the success of different methods.

What the researchers found

The studies showed a wide range of success of different types of settings or screeners in screening eligible people for raised blood pressure. Detection rates varied greatly within and between different settings and types of screeners.

Screening in pharmacies and mobile sites resulted in the highest proportion of screening of the eligible population. Student screeners resulted in the lowest rates of screening.

Dental sites and mobile sites had lower rates of detecting high blood pressure. The two self-screening studies showed detection rates similar to studies including a variety of screening methods and can be considered an effective screening method for detecting blood pressure.

Of participants with high blood pressure who were referred to seek further medical attention, 44% received a new diagnosis or treatment for hypertension

Conclusion

Community-based screening and self-screening may be an effective way to detect raised blood pressure. There is currently too much variability to make strong conclusions about which type of setting or screener is most effective for different populations.