Developing Hypertension Guidelines: An Evolving Process

Hypertension guidelines provide up-to-date information and recommendations for hypertension management to healthcare providers, and they facilitate translation of new knowledge into clinical practice. Guidelines represent consensus statements by expert panels, and the process of guideline development has inherent vulnerabilities. Between 1977 and 2003, under the direction of the National Institutes of Health (NIH), the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC) issued 7 reports. The evolution of the JNC recommendations reflects the acquisition of observational and clinical trial data and the availability of newer antihypertensive drugs. Despite 5 years in preparation, NIH did not release a JNC 8 report and recently made the decision to withdraw from issuing guidelines. The responsibility for issuing hypertension-related guidelines was transferred to the American Heart Association (AHA) and the American College of Cardiology. Without the endorsement of the NIH or the AHA, JNC 8 committee members recently published their guideline report. Notably, there have been discrepancies of JNC recommendations over time as well as discrepancies with recommendations of other professional organizations. The Institute of Medicine recently recommended criteria for "trustworthy" guidelines. Criticisms of the guideline process, and of the guidelines themselves, should not obscure their likely contribution to improved hypertension control and to decreases of mortality rates of stroke and cardiovascular disease over the past several decades. Nevertheless, translation of guidelines into clinical practice remains a challenge.