ESC/ESH Guidelines for the management of arterial hypertension, engl.

Evaluation by Leitlinienwatch

09.01.19

PTs.	Criterion
2	Transparency A detailed list of each author’s conflicts of interest is published on the ESC homepage: https://www.escardio.org/static_file/Escardio/Guidelines/DOI/DOI_Summary_2018_Hypertension.pdf There is no documentation regarding the evaluation of the conflicts of interest.
0	Composition of the Guideline Working Group 24 out of 28 authors in the guideline working group declare financial conflicts of interest, the majority of which are connected to the subject of the guideline (arterial hypertension).
0	Independence of the Coordinators/Chairs/Lead AuthorsUnabhängigkeit der Vorsitzenden/federführenden Autoren Both lead authors declare financial conflicts of interest that are connected to the subject of the guideline.
0	Abstention from Voting There is no documented rule regarding abstention.
0	External Review of the Guideline An external review via a publicly accessible website did not occur.
0	Bonus Points The guideline documentation does not include any further measures to reduce conflicts of interest.

Explanations to the evaluation criteria

Comment

As with the previous nine ESC guidelines we have analyzed, this set of guidelines also does not tackle conflicts of interest in an appropriate or contemporary way.
Furthermore, no efforts appear to have been made to regulate conflicts of interest and, consequently, to reduce the industry’s influence on the guideline process. In that sense, these guidelines do not meet the same quality standards as, say, the new German AWMF guidelines, which include established methods for regulating conflicts of interest.
The ESC’s policy on conflicts of interest is unacceptable here for two reasons in particular: First, it is problematic considering the epidemiological importance of arterial hypertension and its relevance to medical economics (in the sense that it is a widespread public health issue) and take into account the expected reach that these guidelines will have. And second, it is problematic given the fact that, compared to the previous version of the guidelines from 2013, therapeutic goals are now much more ambitious and recommendations have been expanded. The guideline now call for a much lower target blood pressure and an increasingly earlier intervention with medication (see section 2.1 of the guideline).

The Deutsche Gesellschaft für Kardiologie (German Society of Cardiology) generally adopts the ESC guidelines without alterations. The management of conflicts of interest within the scientific medical societies for cardiology requires comprehensive reform.
The recommendations from the Guideline International Network and the AWMF could serve as a model here.
Important aspects of any potential reform would include the recruitment of independent authors and measures to effectively regulate the existing and often substantial conflicts of interest of the guideline authors.