Additional research aimed at development of practical approaches to implemen- tation of clinical and population-based strategies to prevent obesity, increase physical fitness, and control excess salt and sugar intake could have significant public health impact. In addition, there are minimal, if any, data on whether treatment of hypertension during pregnancy mitigates risk; thus, there is a need for further research in this area, considering both proximate (during the pregnancy and postpartum period) and distant (CVD prevention) outcomes.S15-1 In the very old, frailty and higher risk of medication side effects complicate treatment. Additional knowledge of the effects of antihypertensive treatment for patients with demen- tia and patients who reside in long-term-care facility settings is needed. The best approach to older persons who have supine hypertension but postural hypotension needs to be clarified. 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. Presidents and Staff American College of Cardiology Mary Norine Walsh, MD, MACC, President Shalom Jacobovitz, Chief Executive Officer William J. Oetgen, MD, MBA, FACC, Executive Vice President, Science, Education, Quality, and Publishing MaryAnne Elma, MPH, Senior Director, Science, Education, Quality, and Publishing Amelia Scholtz, PhD, Publications Manager, Science, Education, Quality, and Publishing American College of Cardiology/American Heart Association Katherine A. Sheehan, PhD, Director, Guideline Strategy and Operations Abdul R. Abdullah, MD, Science and Medicine Advisor Naira Tahir, MPH, Associate Guideline Advisor American Heart Association John J. Warner, MD, President Nancy Brown, Chief Executive Officer Rose Marie Robertson, MD, FAHA, Chief Science and Medicine Officer Gayle R. Whitman, PhD, RN, FAHA, FAAN, Senior Vice President, Office of Science Operations Jody Hundley, Manager, Production and Operations, Scientific Publications, Office of Science Operations Whelton et al 2017 High Blood Pressure Clinical Practice Guideline e79 References Preamble P-1. Gibbons GH, Harold JG, Jessup M, et al. The next steps in devel- oping clinical practice guidelines for prevention. Circulation. 2013;128:1716 7. P-2. Gibbons GH, Shurin SB, Mensah GA, et al. Refocusing the agenda on cardiovascular guidelines: an announcement from the National Heart, Lung, and Blood Institute. Circulation. 2013;128: 1713 5. P-3. Committee on Standards for Developing Trustworthy Clinical Practice Guidelines, Institute of Medicine (U.S.). 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