The Department of Veterans Affairs and the Department of Defense of The United States, recognized a joint clinical practice guideline in January 2020 to help diagnose and manage hypertension in the primary care level.
The VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development venture, involving a multi-disciplinary panel of practicing clinician stakeholders, adapted to the Institute of Medicine’s principles for trustworthy clinical practice guidelines.In January 2020, an update to the 2014 joint clinical practice guideline was approved by the same bodies to assess and manage hypertensive patients. The guideline panel had developed key questions, systematically searched, and evaluated the literature, and improved 28 recommendations using the GRADE system and two single-paged algorithms.
The GRADE system assessed the strength of each recommendation, using these four domains:
- balance of desirable and undesirable outcomes;
- confidence in the quality of the evidence;
- patient or provider values;
- and preferences and other implications,
The workgroup determined the relative strength of each recommendation using these domains. This summary highlights some of the guideline’s recommendations in four areas relating to hypertension:
- screening, diagnosis, and monitoring
- treatment goals and general approaches
- nonpharmacologic and pharmacologic treatment
In essence, the VA/DoD guideline provides recommendations based on evidence for outpatient evaluation and the management of hypertension in adults. The goal being the successful patient-centric management to enhance clinical ends.