The guideline development process for the 2020 VA/DoD HTN CPG update consisted of the following steps: 1. Formulating and prioritizing KQs and defining critical outcomes 2. Convening a patient focus group 3. Conducting the systematic evidence review 4. Convening a face-to-face meeting with the CPG Champions and Work Group members to develop recommendations 5. Drafting and submitting a final CPG on the management of HTN to the VA/DoD EBPWG Appendix A provides a detailed description of each of these tasks. a. Grading Recommendations The Champions and Work Group used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to assess the quality of the evidence base and assign a strength for each recommendation. The GRADE system uses the following four domains to assess the strength of each Balance of desirable and undesirable outcomes Confidence in the quality of the evidence Patient or provider values and preferences Other implications, as appropriate, e.g.: Resource use Equity Acceptability Feasibility Subgroup considerations Additional information regarding these domains can be found in Appendix A. Using these four domains, the Work Group determined the relative strength of each recommendation ( Strong or Weak ). Generally, a Strong recommendation indicates a high confidence in the quality of the available scientific evidence, a clear difference in magnitude between the benefits and harms of an intervention, similar patient or provider values and preferences, and understood influence of other implications (e.g., resource use, feasibility). Generally, if the Work Group has less confidence after the assessment across these domains and believes that additional evidence may change the recommendation, it assigns a Weak recommendation. It is important to note that the GRADE terminology used to indicate the assessment across the four domains (i.e., Strong versus Weak ) should not be confused with the clinical importance of the recommendation. 