The “2013 ESH/ESC Guidelines for the management of arterial hypertension”, which recommend several significant changes to hypertension treatment, were officially presented at the 23rd Scientific Meeting of the European Society of Hypertension in Milan.

The Task Force for Hypertension Management of the European Society of Hypertension presents the Reappraisal of European Guidelines on Hypertension Management: a European Society of Hypertension Task Force document.

Introduction to the latest guidelines

In the 2 years since the publication of the 2007 guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC), research on hypertension has actively been pursued and the results of new important studies (including several large randomized trials of antihypertensive therapy) have been published. Some of these studies have reinforced the evidence on which the recommendations of the 2007 ESH/ESC guidelines were based. However, other studies have widened the information available in 2007, modifying some of the previous concepts, and suggesting that new evidence-based recommendations could be appropriate.

The aim of this document of the ESH is to address a number of studies on hypertension published in the last 2 years in order to assess their contribution to our expanding knowledge of hypertension. Furthermore, some critical appraisal of the current recommendations of the ESH/ESC, as well as of other guidelines, might be a useful step toward the preparation of a third version of the European guidelines in the future.

Introduction and Purposes

For several years the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) decided not to produce their own guidelines on the diagnosis and treatment of hypertension but to endorse the guidelines on hypertension issued by the World Health Organization (WHO) and International Society of Hypertension (ISH) with some adaptation to reflect the situation in Europe. However, in 2003 the decision was taken to publish ESH/ESC specific guidelines based on the fact that, because the WHO/ISH Guidelines address countries widely varying in the extent of their health care and availability of economic resource, they contain diagnostic and therapeutic recommendations that may be not totally appropriate for European countries. In Europe care provisions may often allow a more in- depth diagnostic assessment of cardiovascular risk and organ damage of hypertensive individuals as well as a wider choice of antihypertensive treatment.

In preparing the new guidelines the Committee established by the ESH and ESC has agreed to adhere to the principles informing the 2003 Guidelines, namely:

  1. to try to offer the best available and most balanced recommendation to all health care providers involved in the management of hypertension;
  2. to address this aim again by an extensive and critical review of the data accompanied by a series of boxes where specific recommendations are given, as well as by a concise set of practice recommendations to be published soon thereafter as already done in 2003;
  3. to primarily consider data from large randomized trials but also to make use, where necessary, of observational studies and other sources of data, provided they were obtained in studies meeting a high scientific standard;
  4. to emphasize that guidelines deal with medical conditions in general and therefore their role must be educational and not prescriptive or coercive for the management of individual patients who may differ widely in their personal, medical and cultural characteristics, thus requiring decisions different from the average ones recommended by guidelines;
  5. to avoid a rigid classification of recommendations by the level or strength of scientific evidence. The Committee felt that this is often difficult to apply, that it can only apply to therapeutic aspects and that the strength of a recommendation can be judged from the way it is formulated and from reference to relevant studies. Nevertheless, the contribution of randomized trials, observational studies, meta-analyses and critical reviews or expert opinions has been identified in the text and in the reference list.

Click here to see the guidelines.