ESH '07: New Consensus Hypertension Guidelines From the European Society of Hypertension/European Society of Cardiology (ESH/ESC)

Linda Brookes, MSc

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September 17, 2007

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Invited discussant Lars H. Lindholm, MD, PhD (Umea University, Umea, Sweden), current President of the International Society of Hypertension (ISH) and coauthor of new ISH/World Health Organization (WHO) guidelines to be published shortly, commended the new European guidelines for being "comprehensive and well written and free from speculation." However, Prof. Lindholm, who is a well-known critic of beta-blockers in hypertension,[18,19,20] criticized their inclusion as first-line treatment, noting that recent guidelines, such as those produced in the United Kingdom[15] and by the AHA,[6] do not include beta-blockers as first-choice antihypertensive treatment. He suggested that the ESH/ESC guidelines list so many groups of patients in whom beta-blockers would be inappropriate that "it might have been wiser to take them off the list." Prof. Lindholm also questioned the cost of implementing the guidelines, which, he noted, recommend many visits and work-ups.

A second discussant, Suzanne Oparil, MD (University of Alabama at Birmingham School of Medicine), current President of the American Society of Hypertension (ASH), praised the scholarship of the guidelines, while also expressing reservations about their complexity. For primary care physicians it might be better to focus on blood pressure, the most easily modifiable cardiovascular risk factor, rather than including all risk factors and the metabolic syndrome, she suggested. She also noted that in the United States, guidelines cannot omit grading of recommendations according to level of scientific evidence, as in the European guidelines.

Discussion about the divergence between the European and UK guidelines has continued. The British Hypertension Society has recommended that its members continue to follow the current UK guidelines produced by the National Institute for Clinical Excellence (NICE) rather than adopt the European guidelines.[21] In the July issue of the British journal Heart, Jan A. Staessen, MD, PhD (University of Leuven, Leuven, Belgium) and Eoin O'Brien, MD, PhD (The Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Ireland), an ESH/ESC guidelines coauthor, made a plea for harmonization of European hypertension guidelines.[22] "The international opinion leaders know each other and should be able to come together to produce an international consensus guideline on hypertension, which would relieve practitioners from the burden of identifying the differences in policies between the guidelines," they said. "Realistically, we know that international consensus is unlikely, but surely European agreement should be possible, which begs the question as to why there have to be British guidelines within the context of the European Union."

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