Linda Brookes, MSc
Presenter: Professor Giuseppe Mancia, MD, PhD, University of Milan-Bicocca (Milan, Italy) and S Gerardo Hospital (Monza, Italy)

◆引言

New guidelines for the management of arterial hypertension were announced by the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) and officially presented to the 2003 ESH meeting by Professor Giuseppe Mancia, MD, PhD,[1] Guidelines Committee chairman, with simultaneous publication in the Journal of Hypertension.[2] The goal of the new guidelines is to update the 1999 World Health Organization (WHO)/International Society of Hypertension (ISH) guidelines,[3] which the ESH/ESC had previously endorsed but then decided to revise.

ESC/ESH felt that a new European set of guidelines was called for since the WHO/ISH guidelines were necessarily written for a global audience, with a wide range of healthcare needs and resources. By contrast, Europe is a more homogeneous community with greater expected personal longevity and a higher incidence of cardiovascular disease, often despite well-developed heathcare systems. In promulgating the revision, the new document follows the WHO/ISH call for more regional guidelines, and consequently has been endorsed by ISH.

The European guidelines are also noticeably different from the recently announced US guidelines, JNC 7[4,5] [see related links], in that they are being published as the full document first, followed by the shorter version -- due to be published in a few months' time, initially in English. (The JNC 7 guidelines were published in May in "express" form, to be followed by the unabridged publication later this year.) Major differences between the contents of the 2 sets of guidelines include the method of classification of blood pressure and the treatment recommendations; the European recommendations intended to establish greater flexibility in their approach.

The new guidelines state that their goal is to offer the best available and most balanced information to all those involved in the management of arterial hypertension. They were prepared on the principle that guidelines should be educational rather than merely prescriptive, and the committee has emphasized that it has avoided rigid classifications for its recommendations. In another departure from JNC 7, the guidelines are based on the strength of available evidence, with the scientific evidence drawn from many sources and not only from clinical trials and their meta-analyses. Although the committee acknowledges the value of evidence-based randomized trials, they believe that they have some limitations, notably:

1. They often select high risk patients.
2. Their power for secondary endpoints is often inadequate.
3. The therapeutic programs often differ from clinical practice.

The committee notes that controlled randomized hypertension trials last for only 4-5 years, whereas middle-aged hypertensive individuals may be on medication for 20-30 years. Therefore, the data available to date do not adequately reflect the long-term implications of patient management.

Most importantly for the new guidelines, the committee says it has tried to avoid handing down rigid rules that would constrain clinical judgment on the management of individual patients, who invariably differ in their personal, medical, and cultural characteristics.

编辑 郑麓薇