Further research related to shared decision-making with patients and their families is needed. Examples include areas where evidence does not clearly identify one treatment or goal as substantially better than another, where improved patient knowledge (or improved provider knowledge of the patient s circumstances) might improve compliance, where reliance on patient collaboration improves achievement of outcomes (eg, HBPM, use of social media), and where there are competing health concerns (eg, older individuals with frailty). Finally, clinical guidelines are increasingly required to man- age the large body of accumulated knowledge related to diag- nosis and management of high BP. However, guidelines often cause controversy and confusion when competing recommen- dations are made by different expert groups or when changes in definitions, treatments, or treatment goals are introduced. Now may be the time to begin the investigation of the impact of guidelines on clinical practice, costs, and patient outcomes, as well as ways to facilitate communication and collaboration between different guideline-developing organizations. This document is, as its name implies, a guide. In managing patients, the responsible clinician s judgment remains paramount. 