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AHRQ-supported Task Force issues new recommendations on high blood pressure screening and promotion of breastfeeding

The U.S. Preventive Services Task Force recently issued two new recommendations, one on screening of adults for high blood pressure and the other on programs to encourage new mothers to breastfeed their babies. The Task Force, which is the leading independent panel of private-sector experts in prevention and primary care, is sponsored by the Agency for Healthcare Research and Quality. The Task Force is chaired by Alfred O. Berg, M.D., who is also Chair of the Department of Family Medicine at the University of Washington in Seattle.

The Task Force conducts rigorous, impartial assessments of all the scientific evidence for a broad range of preventive services. Task Force recommendations are considered the gold standard for clinical preventive services. The Task Force grades the strength of the evidence "A" (strongly recommends), "B" (recommends), "C" (no recommendation for or against), "D" (recommends against) or "I" (insufficient evidence to recommend for or against screening).

The new recommendations are summarized here. Previous Task Force recommendations, summaries of the evidence, easy-to-read fact sheets explaining the recommendations, and related materials are available from the AHRQ Publications Clearinghouse.

Clinical information is also available from the National Guideline Clearinghouse™.

Screening for high blood pressure. The Task Force has reaffirmed its earlier recommendation that clinicians measure the blood pressure of all adults who are 18 and older because of good evidence that early detection and treatment of high blood pressure can significantly reduce the risk of cardiovascular disease. The recommendations, published in the August 1, 2003, issue of the American Journal of Preventive Medicine, update those made by the Task Force in 1996.

High blood pressure, also known as hypertension, affects approximately one-quarter of the adult population of the United States, or roughly 50 million people. It can cause heart attacks, heart failure, stroke, kidney failure, and other serious problems. However, one-third of patients with high blood pressure are unaware that they have the disease because they lack warning signs and symptoms and have not been screened.

The Task Force also looked at blood pressure measurement in children and adolescents but found insufficient evidence that it accurately identifies those who have a higher risk of developing cardiovascular disease and insufficient evidence that treating it decreases the incidence of CVD.

The Task Force strongly recommends that clinicians measure blood pressure of all adults, an "A" recommendation. The Task Force found insufficient evidence to recommend for or against blood pressure screening of children and adolescents, an "I" recommendation.

The Task Force based its conclusions on an AHRQ-sponsored report prepared by a team led by Stacey Sheridan, M.D., of the RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center in Research Triangle Park, N.C.

Breastfeeding. The Task Force recommends structured education and counseling programs to promote breastfeeding because such programs increase the proportion of women who begin and continue to breastfeed their babies. Simply telling mothers they should breastfeed or giving them pamphlets is not enough, according to the Task Force.

In issuing their recommendation, the Task Force noted that structured programs share some elements: they include from one to eight individual or group sessions that follow specific formats and last between 30 and 90 minutes; they are led by specially trained nurses, midwives, lactation specialists, and peer counselors; and they include lectures along with practical skills that help women master breastfeeding techniques and deal with problems that may arise from breastfeeding. In addition, structured programs include information about the benefits of breastfeeding for mother and child, how the body produces breast milk, training in positioning the baby and latch-on techniques, and the use of mechanical breast pumps.

The Task Force recommendations, which appear in the July/August issue of Annals of Family Medicine, are based on a systematic review of 35 studies, including 22 randomized controlled trials of breastfeeding counseling. They examined the effects of education, support, and written materials on increasing breastfeeding rates.

Meanwhile, the Task Force found insufficient evidence to recommend less-intensive interventions such as having primary care providers give mothers advice or written materials such as pamphlets. The Task Force also found insufficient evidence for peer counseling alone, although some studies show that peer support can enhance structured education programs by encouraging women after they begin to breastfeed to continue the practice longer than they otherwise might. Peer counselors are women who have practical training but not necessarily clinical expertise in breastfeeding techniques.

The Task Force found that supplementing successful programs by providing ongoing support to new mothers through in-person visits or telephone contacts by providers or counselors may help women to stay with breastfeeding for periods longer than 3 months. However, more research is needed in this area. It was clear that providing ongoing support to women is not effective as a stand-alone strategy for increasing rates of breastfeeding.

National data from 1998 showed that 64 percent of all mothers breastfed immediately after giving birth, but only 29 percent of all mothers and 19 percent of black mothers were still breastfeeding by 6 months. The goal for Healthy People 2010 is 75 percent of mothers to be breastfeeding right after having a baby, 50 percent at 6 months, and 25 percent at 1 year.

Although the programs reviewed by the Task Force did not all take place in primary care clinics, the Task Force highlighted the important role of primary care clinicians in referring women to breastfeeding programs to ensure they begin and continue to breastfeed.

The Task Force recommends structured breastfeeding education and behavioral counseling programs to promote breastfeeding, a "B" recommendation. The Task Force found insufficient evidence to recommend for or against brief education and counseling by primary care providers, peer counseling used alone and initiated in the clinical setting, and written materials, used alone or in combination with other interventions, an "I" recommendation. The Task Force based its conclusions on a report prepared by a team led by Jeanne-Marie Guise, M.D., M.P.H., at AHRQ's Evidence-based Practice Center at Oregon Health & Sciences University in Portland.

Select to access counseling for breastfeeding recommendations and materials for clinicians.

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