2003 European Society of Hypertension–European Society of Cardiology guidelines for the management of arterial hypertension*

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In preparing these guidelines the Committee established by the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) has aimed at offering the best available and most balanced information to all those involved in the management of arterial hypertension. The Committee is aware that it is easier to prepare guidelines on a medical condition in general than to deal with the individual patients with that condition requiring medical advice and intervention. Because of this awareness, the Committee has tried to avoid giving rigid rules that would constrain judgement on the management of individual patients differing in their personal, medical and cultural characteristics.
In the past, the European Society of Hypertension, together with the European Society of Cardiology, did not draw up specific guidelines on hypertension but chose to endorse guidelines prepared by the World Health Organization (WHO)/International Society of Hypertension (ISH) Liaison Committee [1,2], and to incorporate them, with some adaptation, into joint European recommendations for the prevention of coronary heart disease [3,4].
Since 1999, considerable new evidence on some of the important issues left open in the 1999 WHO/ISH guidelines has accumulated, requiring the present update of the guidelines. Moreover, the WHO/ISH guidelines are written for a global audience from countries that vary widely in the extent of their health care provision and the availability of resources. Europe is a much more homogeneous community, with populations enjoying greater longevity but suffering a higher incidence of chronic cardiovascular disease, often despite well-developed health systems devoting high proportion of resources to disease prevention. With the preparation of these guidelines, the European Society of Hypertension and the European Society of Cardiology respond to the suggestion of the WHO/ISH guidelines that regional experts draw up recommendations specifically directed toward the management of patients in their own region [2]. Consequently these guidelines are also endorsed by the International Society of Hypertension.
These guidelines have been prepared on the basis of the best available evidence for all key recommendations, and with the principle that guidelines should be educational rather than merely prescriptive. The Committee members take the view that, although large randomized controlled trials and meta-analyses provide the strongest evidence about several aspects of therapy, scientific evidence is drawn from many sources, and where necessary all sources have been used. Therefore, the Committee has avoided rigid classification of its recommendations dependent upon the strength of available evidence. However, for readers preferring a more critical assessment of the evidence, these recommendations have been accompanied by relevant references, and those articles based on large randomized trials, meta-analyses or large observational studies have been clearly identified. Furthermore, for practitioners wishing to receive concise advice, these guidelines will be complemented by a brief set of Practice Recommendations.
The members of the Guidelines Committee, established by the ESH and ESC, have participated independently in the preparation of this document, drawing on their academic and clinical experience and utilizing an objective and critical examination of all available literature. Most have undertaken, and are undertaking, work in collaboration with industry and governmental or private health providers (research studies, teaching conferences, consultation), but all believe such activities haven not influenced their judgement. The best guarantee of their independence is in the quality of their past and current scientific work. However, to ensure openness, their relations with industry, government and private health providers are listed in the Appendix at the end of these guidelines. Expenses for the Writing Committee and preparation of these guidelines were provided entirely by the European Society of Hypertension.

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