Harold C. Sox, M.D., of the Dartmouth Institute for Health Policy and Clinical Practice, Hanover, N.H., calls attention to the fact that the 2014 hypertension guideline did not undergo specialty society review as was originally planned, and he addresses the trustworthiness of the guideline, and guidelines in general, in an editorial.
He asks “First, what are the key elements of trustworthiness in a guideline? Second, how does this guideline measure up? Third, what is the role of expert review of guidelines? Fourth, what is the pathway to guidelines that the public can trust?”
He ultimately concludes that the panel of guideline authors, by agreeing to share its record of the review process with anyone who asks, meets the standard of transparency and review that proper guideline development now requires. “A rigorous, transparent process for developing and reviewing guidelines matters a great deal because guidelines are increasingly driving the practice of medicine.”
(doi:10.l001/jama.2013.284429; Available pre-embargo to the media at media.jamanetwork.com)
Editor’s Note: Please see the article for additional information, including financial disclosures, funding and support, etc.
Editorial: Updated Guidelines for Management of High Blood Pressure - Recommendations, Review, and Responsibility
Howard Bauchner, M.D., Editor in Chief, JAMA, Chicago, and colleagues comment on the production of guidelines.
“Producing guidelines in the United States has become increasingly more complicated and contentious. This likely reflects the strongly held beliefs of many stakeholders, including physicians and patients. For instance, the Infectious Diseases Society of America was embroiled in complicated legal proceedings after producing guidelines for the management of Lyme disease. There was a great deal of reaction from health professionals and the public after the U.S. Preventive Services Task Force released updated recommendations regarding mammography screening in women. Recently, in June 2013, the NHLBI announced its decision to discontinue its participation in the development of clinical guidelines, including the hypertension guideline. (Accordingly, as the authors clearly indicate, ‘This report is therefore not an NHLBI sanctioned report and does not reflect the views of NHLBI.’) Instead, the NHLBI has partnered with and shifted the responsibility for generating guideline products to selected specialty organizations, such as the American College of Cardiology and the American Heart Association, whose recently released guidelines on assessment of cardiovascular risk and treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk have been met with controversy.”
“Rigorously developed, thoroughly reviewed, evidence-based, trustworthy guidelines are critical to advance clinical medicine and improve health, and biomedical journals have a responsibility to disseminate important guidelines in an objective manner. We are pleased to publish the ‘2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults’ from the panel members appointed to the Eighth Joint National Committee (JNC8). We anticipate debate and discussion about the clinical application of these recommendations and the related policy issues. JAMA welcomes this responsibility, and indeed, embraces the opportunity to provide evidence-based recommendations to help clinicians improve the care of their patients.”
Editor’s Note: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
Editorial: Recommendations for Treating Hypertension - What Are the Right Goals and Purpose?
Eric D. Peterson, M.D., M.P.H., of Duke University Medical Center, Durham, N.C., and colleagues write in an accompanying editorial that “while it is likely that there will be considerable controversy in hypertension treatment for the foreseeable future, several critical next steps are needed.”