Hypertension guidelines: political correctness trumping expertise?

Hypertension Guidelines: Political Correctness Trumping Expertise? To the Editor: Guidelines are traditionally scripted by a panel of experts who are intimately familiar with the topic in question. Webster’s dictionary defines an expert as someone who is “having, involving, or displaying special skill or knowledge derived from training or experience.” A straightforward way to estimate such expertise is to scrutinize the publication list of an expert to assess how often he or she has been involved with the guideline topic. Additionally, one may consider an expert’s membership in professional organizations pertaining to the subject matter, which demonstrates an interest in the disease. Not uncommonly also, true experts recognized by their peers are asked to serve on editorial boards of journals dealing with the topic in question. When one for instance looks at the bibliography of the authors of the Joint National Committee (JNC) 7,1 there is little doubt that most of them had extensively published on hypertensive cardiovascular disease, that is, were indeed true experts displaying skills or knowledge to guide other physicians in detection, evaluation, and treatment of patients with hypertension. Such is unfortunately not the case when canvassing the authors of the recent American Heart Association (AHA)/ American College of Cardiology (ACC)/Center for Disease Control (CDC) Science Advisory pertaining to an Effective Approach on High Blood Pressure Control.2 The Table compares the publications pertaining to hypertension and membership of the authors of JNC 7 with those of the authors of the AHA/ACC/CDC Science Advisory. The highly statistically significant results are self-explanatory. In fact as per PubMed, 2 of the 7 guideline authors have never authored an article on hypertension and 1 has coauthored a single study only. Moreover not one of the experts of the AHA/ACC/CDC Science Advisory is known to be a hypertension specialist certified by the American Society of Hypertension (ASH) or even a member of ASH or of the AHA Council for High Blood Pressure. Not one of them has been asked to serve on the editorial board of a journal dealing with hypertension. On a positive note, compared with the JNC 7 authors, the AHA/ACC/CDC Science Advisory has a much shorter list of conflict of interests and consists of a more diversified group of people. We are not privileged to have access to the selection criteria for the authors of these guidelines. Clearly, they must have been other than expertise in hypertensive cardiovascular disease, that is, “special skill or knowledge derived from training or experience.”