Discussion The recommendations based on RCT evidence in this guideline dif- fer from recommendations in other currently used guidelines sup- guidelines recommended treatment to lower BP goals in patients with diabetes and CKD based on observational studies.12 Recently, several guideline documents such as those from the American Dia- betesAssociationhaveraisedthesystolicBPgoalstovaluesthatare Other guidelines such as those of the European Society of Hyper- tension also recommend a systolic BP goal of lower than 150 mm Hg, albeit in patients older than 80 years (not 60 years as recom- Thischanginglandscapeisunderstand- ablegiventhelackofclearRCTevidenceinmanyclinicalsituations. History of JNC 8 The panel was originally constituted as the Eighth Joint National Committee on the Prevention, Detection, Evaluation, and Treat- ment of High Blood Pressure (JNC 8). In March 2008 NHLBI sent letters inviting the co-chairs and committee members to serve on JNC 8. The charge to the committee was as follows: The JNC 8 will review and synthesize the latest available scientific evidence, up- dateexistingclinicalrecommendations,andprovideguidancetobusy primary care clinicians on the best approaches to manage and con- trol hypertension in order to minimize patients risk for cardiovas- cular and other complications. The committee was also asked to identify and prioritize the most important questions for the evi- dence review. In June 2013, NHLBI announced its decision to dis- continue developing clinical guidelines including those in process, instead partnering with selected organizations that would develop Importantly, participation in this process re- quired that these organizations be involved in producing the final content of the report. The panel elected to pursue publication in- dependentlytobringtherecommendationstothepublicinatimely manner while maintaining the integrity of the predefined process. This report is therefore not an NHLBI sanctioned report and does not reflect the views of NHLBI. Conclusions Itisimportanttonotethatthisevidence-basedguidelinehasnotre- nition from JNC 7 remains reasonable. The relationship between naturallyoccurringBPandriskislineardowntoverylowBP,butthe benefitoftreatingtotheselowerlevelswithantihypertensivedrugs is not established. 