ESC Guidelines for the management of elevated blood pressure and hypertension, engl.

Year of publication: 2024

Editing medical society(ies):
European Society of Cardiology (ESC)

Other medical societies involved: 2

ESC Guidelines


List of evaluated guidelines

Evaluation by Leitlinienwatch

19.10.24


PTs.

Criterion
2

Transparency

Conflicts of interest are documented for each participating author and reviewer with details of the companies involved. There is no documentation of an evaluation/grading of existing COIs.
1

Composition of the Guideline Working Group

Twelve out of 24 members of the guideline task force declared relevant financial conflicts of interest, 9 of which were described as directly related to the guideline topic. However, the three other members have COIs with pharmaceutical companies that offer products for the treatment of hypertension as well.
1

Independence of the Coordinators/Chairs/Lead AuthorsUnabhängigkeit der Vorsitzenden/federführenden Autoren

Two members of the guideline group are named as "chairpersons" and two others as "task force co-ordinators". One of the coordinators declares a COI which is directly related to the guideline's topic.
0

Abstention from Voting

A rule for abstentions from voting in case of financial conflicts of interest is not documented. There are several ESC policy documents on how to deal with conflicts of interest, but it is unclear whether abstention rules mentioned therein only apply to ESC members in leadership positions or to all participants (ESC Declaration and Management of Conflict of Interest Policy - https://www.escardio.org/The-ESC/About/Policies/esc-declaration-and-management-of-conflict-of-interest-policy). Either way, despite several financial COIs, there are no documented abstentions in this guideline.
0

External Review of the Guideline

There was no external review via a publicly accessible website. GPs were consulted, but only with regard to the user-friendliness of the guideline (p. 9 para. 7).
2

Bonus Points

We award a bonus point for a comprehensive and blinded internal ESC review process. The reviewers' conflicts of interest are documented. Unfortunately, a large proportion of them has financial conflicts of interest as well, including the two review coordinators. We award another bonus point for the participation of methodologists and a patient representative in the guideline task force.

Explanations to the evaluation criteria

Overall score

6

Good! (11-18)

Warning! (6-10)

Needs reform! (0-5)

Comment

Like other ESC guidelines before, this one dedicated to hypertension lacks an up-to-date approach to conflicts of interest. The proportion of authors with conflicts of interest is high. Although these COIs are well documented, possible consequences are not. This is particularly concerning given the importance of hypertension as a widespread disease and the enormous reach of this European guideline.
Furthermore, the current version of the guideline once again lowers target blood pressure values and defines "elevated blood pressure" as a precursor to high blood pressure, comparable to so-called "pre-diabetes". The guideline also gives the recommendation to start drug therapy with a two-drug combination instead of a single substance for the majority of patients. Conflicts of interest with the pharmaceutical industry (irrespective of this particular guideline) entail the risk that guideline recommendations emphasize earlier or more intensive pharmacotherapy rather than, for example, lifestyle changes or measures of structural prevention.
Positive aspects of this guideline are the efforts to achieve a pluralistic composition of the guideline group and the extensive (unfortunately not public) review process.
In German-speaking countries, the German "Nationale VersorgungsLeitlinie Hypertonie" (national guideline on hypertension) is an excellent alternative to the ESC guideline.

Supplementary comment from Leitlinienwatch, 1st November 2024: We have adjusted our assessment based on comments and corrections made by the chairs of the guideline group. We only included changes that could be verified by the published guideline documents. As a result, the overall rating has improved from 3 to 6 points.

Note: This evaluation was conducted with due care on the basis of the published guideline. Should you still discover an error, please contact us at info@leitlinienwatch.de.