Hypertension, the world’s most common and modifiable cardiovascular risk factor,1 has been the focus of multiple clinical practice guidelines dating back to the first Joint National Committee in 1977. In 2014, a writing group commissioned by the National Heart, Lung, and Blood Institute focused on a few key treatment questions and used data only from randomized clinical trials (RCTs) to inform their recommendations.2 Based on a lack of RCT evidence, the writing group recommended relaxing some of the treatment goals for several subgroups, including patients aged 60 years or older and those with diabetes or kidney disease. Even before publication, these somewhat conservative recommendations were criticized and ultimately not endorsed either by major professional societies or by some of the original guideline writing group.3
Greenland P, Peterson E. The New 2017 ACC/AHA Guidelines “Up the Pressure” on Diagnosis and Treatment of Hypertension. JAMA. 2017;318(21):2083–2084. doi:10.1001/jama.2017.18605
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