Resolve to Save Lives article recommends every adult patient have blood pressure measured at every medical visit
MAY 7, 2025 – A new article from Resolve to Save Lives published today in The Lancet challenges the common practice of conducting mass public blood pressure screenings and notes that measuring blood pressure in patients attending primary care facilities is a much more efficient and effective way to prevent heart attacks and strokes.
“For every complicated problem, there’s a solution that’s quick, simple, and wrong,” said Dr. Tom Frieden, President and CEO of Resolve to Save Lives and a co-author of the article. “Mass screening is the wrong solution to prevent millions of heart attacks and strokes. The good news is, measuring the blood pressure of all adults visiting health-care facilities and providing them with effective treatment can save millions lives.”
Although mass screenings are commonplace around the world – frequently taking place at community fairs and in other public settings – they hinder effective diagnosis and treatment, according to the article’s authors. The article shows that universal primary care-based screening is a more accurate, reliable, and cost-effective approach to control hypertension.
“Routine blood pressure measurement and detection in health facilities, where people are already seeking care, offers an efficient, sustainable way to detect hypertension, link patients to treatment, and improve follow-up – saving lives and resources far more effectively than mass community screening campaigns,” said Dr. Renu Garg, Senior Vice President of Cardiovascular Health of Resolve to Save Lives and a co-author of the article.
The article addresses three common arguments in favor of mass hypertension screening and shows how the arguments, although intuitively appealing, are incorrect.
The first argument is that screening will find people with high blood pressure who then get treated; a systematic review of 73 community screening programs found that most patients referred for confirmation of hypertension diagnosis did not follow up, most who followed up did not have hypertension, and most with confirmed hypertension were not started on treatment. A mass campaign by the Thai government required screening of 2,500 people to control one person’s hypertension. Facility-based testing would improve control for many more people with the same expenditure of effort and resources. The funding required to conduct a mass screening campaign could be much more effectively invested instead in blood pressure measurement devices for primary health care facilities and ongoing follow-up efforts, including affordable medication.
The second argument – that screening campaigns reach people who don’t use health-care facilities – is also incorrect. People who don’t attend health-care facilities are less likely to participate in screening and follow-up, and measurement of blood pressure among all patients attending heath care facilities identifies a large proportion of people who aren’t yet in regular care.
The third argument, that informing people they have high blood pressure will motivate them to improve their diet and physical activity, lowering their blood pressure – has been disproven by numerous studies, including those conducted in Germany and South Korea, showing that counselling and printed information does not lead to behavioral changes.
The piece suggests that universal facility-based screening is more efficient and more likely to result in linkage to treatment, continuing care, control of hypertension, and prevention of heart attacks and strokes. For example, in Thailand, routine primary health-care services accounted for more than 99% of those with controlled blood pressure.
Hypertension is the leading cause of preventable death worldwide, accounting for nearly 1 in 5 deaths globally. This high burden is mostly due to control: today, only about 20% of people with hypertension have their blood pressure controlled to 140/90 mm Hg or below. Increasing this proportion requires not mass screening but improvements in measurement, treatment, follow-up, and control in primary healthcare facilities.