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J Gen Fam Med. 2018 May 31;19(4):123-126. doi: 10.1002/jgf2.176. eCollection 2018 Jul.

Overdiagnosis or not? 2017 ACC/AHA high blood pressure clinical practice guideline: Consequences of intellectual conflict of interest.

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Takachaya Clinic Tsu City Mie Japan.
Family Medicine Residency Program Mie University Tsu City Mie Japan.


American Heart Association/the American College of Cardiology and nine other professional organizations have issued a new hypertension clinical practice guideline (CPG) on November 2017, which has lowered the hypertension threshold to 130/80 mmHg. American Academy of Family Medicine has decided to not endorse this new CPG for various reasons including flaws in CPG development process and a limited additional benefit for lower treatment targets. The major concern was intellectual conflict of interest (COI). Substantial weight was given to SPRINT trial, which provided the basis for the recommended change in blood pressure targets. It is a serious intellectual COI that the Chair of the SPRINT trial steering committee was commissioned as chair of the guideline panel. The new threshold would lead to 46 percent of the U.S. adult population being categorized as having hypertension, while using the previous threshold that figure would be 32 percent. Should we call this change as overdiagnosis?


clinical practice guidelines we can trust; conflict of interest; hypertension; medical overuse; practice guideline

Conflict of interest statement

5.1Disclosure of COIs (commercial, noncommercial, intellectual, institutional, and patient‐public activities pertinent to the potential scope of the CPG) within Guideline Development Group (GDG) and appropriate exclusion measures should be taken. Disclosure of COIs only reflects financial COIs. Intellectual COIs were not considered, which is a major concern of this CPG and will be discussed in detail in the next section.

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