Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults

Published by ACC/AHA Joint Committee on Clinical Practice Guidelines · ACC/AHA Class of Recommendation and Level of Evidence

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Summary

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The document reviews the background, history, missions, governance, values, and principles related to ACC/AHA guideline development, as well as the format of guideline documents and optimization strategies.

hypertensionACC/AHAcardiologyguidelinesrecommendationsconsensus thresholdpost-publication surveillancemodular recommendation format

Key Takeaways

1
The ACC/AHA guideline development process includes four phases: Pre-Production, Document Development, Review and Approval, and a newly added Phase 4 Post-Publication Surveillance Review and Guideline Revision.
2
The consensus threshold for writing committee approval of recommendations has been increased from >51% to >75%.
3
Guidelines will now use a Modular Recommendation Format (MRF) to organize content, structuring each module with a Class of Recommendation (COR), Level of Evidence (LOE), synopsis, recommendation-specific supportive text, and references.
4
The methodology integrates Shared Decision-Making (SDM) and Patient-Reported Outcomes (PROs), standardizing how evidence from SDM and PROs translates into the COR/LOE framework.

What's New in This Version

Revised Section 3.4.5 to change the recommendation consensus threshold from >51% to >75%. Added new Section 3.7 detailing Phase 4 Post-Publication Surveillance Review and Guideline Revision.

Key Recommendations

9.5.1 Treating Hypertension to Reduce the Incidence of Heart Failure

1
In patients at increased risk, stage A HF, the optimal blood pressure in those with hypertension should be less than 130/80 mm Hg.
1Evidence: C-LDManagement

4.1.7 Shared Decision-Making in Patients With Acute Chest Pain

2
For patients with acute chest pain and suspected ACS who are deemed intermediate risk by a CDP, shared decision-making between the clinician and patient regarding the need for admission, for observation, discharge, or further evaluation in an outpatient setting is recommended for improving patient understanding and reducing low-value testing.
1Evidence: B-REvaluation

Scope & Objectives

Clinical Topic

Clinical Practice Guideline Methodology

Objectives

To describe how the processes of ACC/AHA guideline development are applied to ensure consistency across all guidelines.

Target Patient Population

Patients with cardiovascular conditions

Target Providers

Cardiovascular cliniciansPrimary care cliniciansGuideline developers

Patient Criteria & Setting

Therapeutic Area

Cardiovascular Disease

Guideline Scope

MethodologyGuideline DevelopmentPolicies

Evidence Grading

System: ACC/AHA Class of Recommendation and Level of Evidence

Evidence Levels

Level AHigh-quality evidence from more than 1 RCT, meta-analyses of high-quality RCTs, or one or more RCTs corroborated by high-quality registry studies.

Level B-RModerate-quality evidence from 1 or more RCT or Meta-analyses of moderate-quality RCTs.

Level B-NRModerate-quality evidence from 1 or more well-designed well-executed nonrandomized studies, observational studies or registry studies, or meta-analyses of such studies.

Level C-EOConsensus of expert opinion based on clinical experience.

Level C-LDRandomized or nonrandomized observational or registry studies with limitations of design or execution.

Recommendation Strength

Class 2b (Weak)Benefit ≥ Risk. May/might be reasonable, may/might be considered.

Class 1 (Strong)Benefit >>> Risk. Is recommended, is indicated/useful/effective/beneficial.

Class 2a (Moderate)Benefit >> Risk. Is reasonable, can be useful/effective/beneficial.

Class 3: Harm (Strong)Risk > Benefit. Potentially harmful, causes harm, associated with excess morbidity/mortality.

Class 3: No Benefit (Moderate)Benefit = Risk. Is not recommended, is not indicated/useful/effective/beneficial.

Authors & Contributors

Catherine M. OttoSunil V. RaoJoshua A. BeckmanAbdul R. AbdullahHani JneidAnastasia ArmbrusterHeather M. JohnsonVanessa BlumerWilliam Schuyler JonesLeslie L. DavisSadiya S. KhanSharlene M. DayMichelle M. KittlesonRebecca L. DiekemperVenu MenonDave L. DixonDebabrata MukherjeeVictor A. FerrariDaniel MuñozStephen E. FremesKristen K. PattonMario GaudinoGarima SharmaThomas S. D. GetchiusDaichi ShimboBoback Ziaeian

Guideline Features

Flowcharts includedMultidisciplinaryPatient involvement

Learning Context

Difficulty

advanced

Learning Paths

Guideline MethodologySystematic ReviewEvidence-Based MedicineShared Decision-Making