b If blood pressure fails to be maintained at goal, reenter the algorithm where appropriate based on the current individual therapeutic plan. Clinical Review & Education Special Communication 2014 Guideline for Management of High Blood Pressure E10 JAMA Published online December 18, 2013 jama.com strategies and assess their effects on important health outcomes. There may be evidence that different strategies result in more rapid attainment of BP goal or in improved adherence, but those are intermediate outcomes that were not included in the evi- dence review. Therefore, each strategy is an acceptable pharma- cologic treatment strategy that can be tailored based on indi- vidual circumstances, clinician and patient preferences, and drug tolerability. With each strategy, clinicians should regularly assess BP, encourage evidence-based lifestyle and adherence interven- tions, and adjust treatment until goal BP is attained and main- tained. In most cases, adjusting treatment means intensifying therapy by increasing the drug dose or by adding additional drugs to the regimen. To avoid unnecessary complexity in this report, the hypertension management algorithm (Figure) does not explicitly define all potential drug treatment strategies. Finally,panelmemberspointoutthatinspecificsituations,one antihypertensive drug may be replaced with another if it is per- ceived not to be effective or if there are adverse effects. Limitations This evidence-based guideline for the management of high BP in adults is not a comprehensive guideline and is limited in scope be- tions (Table 1). Clinicians often provide care for patients with nu- merous comorbidities or other important issues related to hypertension, but the decision was made to focus on 3 questions considered to be relevant to most physicians and patients. Treat- ment adherence and medication costs were thought to be beyond the scope of this review, but the panel acknowledges the impor- tance of both issues. 