Henry R. Black, MD


December 19, 2013

This feature requires the newest version of Flash. You can download it here.
In This Article

Guidelines, Not Rules

Hi. This is Dr. Henry Black. I'm an adjunct clinical professor at the New York University Langone School of Medicine, a former President of the American Society of Hypertension, and part of the executive committee that wrote both JNC 6 and JNC 7.

Finally, we have what's been called "JNC 8." It was published in JAMA in December, and it's titled "2014 Evidence-based Guideline for the Management of High Blood Pressure: Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC 8)."[1]

I was not a member of that committee, but I had a chance to review the guideline about 6 months ago and made comments. And there are some very important things that were done and some pretty important things that I think were left out.

The purpose of this was to provide recommendations, and this is a quote:

Although this guideline provides evidence-based recommendations for the management of high BP [blood pressure] and should meet the clinical needs of most patients, these recommendations are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each patient.

That's a very important sentence -- something that we also included in a similar form in both JNC 6 and JNC 7, because guidelines at best are guidance. They are not rules. They're not laws. They provide recommendations from people who are not actually looking at the individual patient in front of the doctor or other healthcare providers; they should not be viewed as rules, but rather as guides.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.