June 20th, 2013

Hypertension and Cholesterol Guidelines Delayed Again as NHLBI Gets Out of the Guidelines Business

The National Heart, Lung and Blood Institute (NHLBI) will no longer issue guidelines, including the much-delayed and much-anticipated hypertension (JNC 8) and cholesterol (ATP 4) guidelines. Instead, the NHLBI will perform systematic evidence reviews that other organizations, including the American Heart Association and the American College of Cardiology, will use as a resource for their own guidelines.

NHLBI Director Dr. Gary Gibbons

NHLBI Director Dr. Gary Gibbons

The exact fate and form of the delayed hypertension and cholesterol guidelines have not yet been decided, though the NHLBI’s Michael Lauer said he was confident that these guidelines would appear in less than a year. But a lot of work remains before the documents can be published. ACC President John Harold said that  “the ACC has not formally agreed to or begun the process of updating” the NHLBI documents, “but we are open to this role and look forward to working out details with NHLBI and the American Heart Association.”

The AHA’s chief science officer, Rose Marie Robertson, said “there are no details sorted out about what might happen yet.” She declined to give a time frame for publication of the documents, but noted that “a lot of work has been done already so it’s not the same as starting from scratch.”

The basic work on the NHLBI’s hypertension and cholesterol documents was completed long ago. The delayed release of the documents has sparked considerable frustration and criticism. Many believe the backlash against the USPSTF’s mammography guidelines prompted the NIH and other public officials to avoid making controversial recommendations.

NHLBI director Gary Gibbons explained on the NHLBI website that “the landscape for guidelines development has changed dramatically. More effective strategies and clinical evidence are available to clinicians and patients.” He cited two reports from the Institute of Medicine “that established new ‘best practice’ standards for generating systematic evidence reviews and developing clinical practice guidelines. The reports underscore that these are two distinct, yet related, activities that require careful intersection and coordination.”

In addition to the hypertension and cholesterol guidelines, the NHLBI has been working on guidance for overweight/obesity in adults, cardiovascular risk assessment, and lifestyle modification. (Gibbons and Lauer are also the authors of an article published online in Circulation and the Journal of the American College of Cardiology explaining the new change.)

Both the ACC and the AHA expressed support for the NHLBI announcement. The AHA said it looks forward “to working closely with the NHLBI and other organizations to create evidence-based guidelines that meet the needs of healthcare providers and the public.” The ACC’s Harold said that the ACC “has been in discussions with NHLBI about the planned change in their approach to guidelines. We agree that it makes sense for medical societies like the ACC to take a strong collaborative role in the guideline development process.”


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