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Table 1 Selected Wilson and Jungner screening criteria adapted to hypertension screening in older adults [27]

From: Screening and treatment of hypertension in older adults: less is more?

Criterion

Criterion related to older adults

The condition sought should be an important health problem

Hypertension CVD and the absolute risk associated with elevated BP in older adults is very high. Hypertension is highly prevalent in the general population and the prevalence increases with age (reaching up to 75% among adults aged 75 years and more).

There should be an accepted treatment for patients with recognized disease

Treatments are accessible and have been shown to be effective among middle-aged adults. The evidence among older adults is much weaker. In frail or multimorbid patients, lowering BP could cause harm [10].

Facilities for diagnosis and treatment should be available

Screening and diagnosis are usually done by primary care physicians. Screening can also be done out of the office, e.g., by pharmacists [69]. Due to the growing number of older adults, provision of treatment will require growing resources, i.e., primary care physicians and other health professionals. To improve hypertension control, novel approaches to care are needed, e.g., team-based care [70].

There should be a recognizable latent or early symptomatic stage

Elevated BP is a causal risk factor for CVD. However, the discriminative power of BP measurement between high- and low-risk patients is weak [28]. Accordingly, other factors such as age and history of CVD are suggested to be more efficient for the assessment of the risk to develop CVD.

There should be a suitable test or examination

Auscultatory or oscillometric methods can be used. For the auscultatory method, training is necessary. For the oscillometric method, a clinically validated device should be used.

The test should be acceptable to the population

BP measurement is well accepted among older adults.

The natural history of the condition, including development from latent to declared disease, should be adequately understood

The relationship between BP and cardiovascular outcomes are not clearly defined in older adults, especially in frail or multimorbid older adults.