JNC 7: brief summary and critique

It is the season for guidelines. During the past month, both the European Society of Hypertension/European Society of Cardiology, and the National High Blood Pressure Education Program (NHBPEP) of the National Heart, Lung, and Blood Institute have published updated consensus recommendations for the prevention and treatment of hypertension (2003 European Society of Hypertension-European Society of Cardiology Guidelines for the Management of Arterial Hypertension. J Hypertens 2003; 221:1011-1053; Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Green LA, Izzo JL Jr, Jones DW, et al. The seventh of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. JAMA 2003; 289:2560-2572). These guidelines seek to meet the needs and aspirations of millions of patients, 100 s of thousands of physicians, as well as health policy and governmental authorities. Confronted by incomplete evidence, conflicting interpretations, and strong professional opinion, writing groups must nevertheless produce a written document within a severely constricted timeframe. It is an ambitious and daunting undertaking. What follows is a selective summary and critique of JNC 7. Criticisms are easy, and will be freely made here, based upon the assumption that the authors suggestion that "the responsible physician's judgment is paramount in managing his or her patients" invites dialogue about the document itself. JNC 7 continues a tradition initiated in 1973 and gets high marks for speed and timeliness, having been created and published in 5 months by a writing group of 10 with review by 33 other "hypertension authorities." The writing group revealed potential financial conflicts, widely reviewed current literature, established and followed defined rules of rating evidence, and functioned entirely without commercial support. Simplicity and brevity were important objectives. The Report was presented at a Press Conference timed to coincide with publication in JAMA. A more detailed supporting document will follow, as will a fold-over card bearing the therapeutic algorithm.