The external review process began when the panel submitted the draft guideline to the NHLBI. According to James et al,1 the NHLBI submitted the guideline to 16 federal agencies and to 20 reviewers, all of whom were experts in hypertension. In addition, individual reviewers were expert in cardiology, nephrology, primary care, pharmacology, research (including clinical trials), biostatistics, and other related fields. The authors report that they received responses from 16 individual reviewers and 5 reviewers from federal agencies. The panel revised the guideline, completing its work in June 2013, just as the NHLBI announced that it was turning the guideline development process over to the American Heart Association and the American College of Cardiology, which jointly sponsor a respected guidelines program.4 Rather than submit the hypertension guideline for review by these organizations, the panel members submitted the guideline to JAMA, where it underwent both internal and external peer review.