major chronic diseases of middle and older ages. For people with unusual family histories of disease, or other medical concerns, screening procedures can vary at the discretion of the physician.

Screening for Hypertension and High Blood Cholesterol

The U.S. Preventive Services Task Force recommends screening for hypertension for all children and adults (U.S. Preventive Services Task Force, 1996). The prevalence of hypertension increases with age, and it is more common in African Americans than whites. It is estimated that 40– 50 million Americans have hypertension (Burt et al., 1995). Office sphygmomanometry (use of the blood pressure cuff) is the most appropriate way to screen for hypertension in the general population. However, there are special problems with accuracy when testing children under the age of 3. (The definition of hypertension in childhood is somewhat arbitrary, based on age-specific percentiles.)

There is a positive relationship between the magnitude of blood pressure elevation and the benefits of treatment. In persons with malignant hypertension, the benefits of treatment are most dramatic: treatment increases 5-year survival from near 0 to 75% (Hansson, 1988). The efficacy of treating less severe hypertension has been demonstrated in randomized clinical trials. The greatest benefits are associated with reduction in morbidity and mortality from stroke. Improved detection and treatment of high blood pressure is responsible for a substantial portion of the greater than 50% reduction in age-adjusted stroke mortality that has been observed in this country since 1972 (Joint National Committee on Detection and Treatment of High Blood Pressure, 1993). The Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure and the American Heart Association recommend blood pressure measurement at least once every 2 years for adults with a diastolic blood pressure below 85 mm Hg (millimeters of mercury) and a systolic pressure below 130 mm Hg. More frequent testing is recommended for persons with higher measures, with frequency depending on degree of elevation. The American Academy of Pediatrics, the American Medical Association, and the American Heart Association recommend that children and adolescents have their blood pressure monitored every 1 or 2 years during regular office visits to a physician (U.S. Preventive Services Task Force, 1996).

Along with hypertension, elevated blood cholesterol is a major modi-



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