These 2018 ESC/ESH Guidelines for the management of arterial hypertension are designed for adults with hypertension, i.e. aged ≥18 years. The purpose of the review and update of these Guidelines was to evaluate and incorporate new evidence into the Guideline recommendations. The specific aims of these Guidelines were to produce pragmatic recommendations to improve the detection and treatment of hypertension, and to improve the poor rates of BP control by promoting simple and effective treatment strategies.
These joint 2018 Guidelines follow the same principles upon which a series of hypertension Guidelines were jointly issued by the two societies in 2003, 2007, and 2013. These fundamental principles are: (i) to base recommendations on properly conducted studies, identified from an extensive review of the literature; (ii) to give the highest priority to data from randomized controlled trials (RCTs); (iii) to also consider well-conducted meta-analyses of RCTs as strong evidence (this contrasts with network meta-analyses, which we do not consider to have the same level of evidence because many of the comparisons are non-randomized); (iv) to recognize that RCTs cannot address many important questions related to the diagnosis, risk stratification, and treatment of hypertension, which can be addressed by observational or registry-based studies of appropriate scientific calibre; (v) to grade the level of scientific evidence and the strength of recommendations according to ESC recommendations (see section 1); (vi) to recognize that opinions may differ on key recommendations, which are resolved by voting; and (vii) to recognize that there are circumstances in which there is inadequate or no evidence, but that the question is important for clinical practice and cannot be ignored. In these circumstances, we resort to pragmatic expert opinion and endeavour to explain its rationale.
Each member of the Task Force was assigned specific writing tasks, which were reviewed by section co-ordinators and then by the two chairs, one appointed by the ESC and the other by the ESH. The text was developed over approximately 24 months, during which the Task Force members met collectively and corresponded intensively with one another between meetings. Before publication, the document was reviewed by European reviewers selected by the ESC and ESH, and by representatives of ESC National Cardiac Societies and ESH National Hypertension Societies.