Page 6 - GUIAS ESC ESH 2018

6 ESC/ESH Guidelines

Table 1 ESC Classes of recommendations

Classes of Definition Suggested wording to use
recommendations
Class I Evidence and/or general agreement Is recommended/is
that a given treatment or procedure is indicated
beneficial, useful, effective.
Class II Conflicting evidence and/or a
divergence of opinion about the
usefulness/efficacy of the given
treatment or procedure.
Class IIa Weight of evidence/opinion is in favour Should be considered
of usefulness/efficacy.
Class IIb Usefulness/efficacy is less well May be considered
established by evidence/opinion.
Class III Evidence or general agreement that Is not recommended
the given treatment or procedure is
not useful/effective, and in some cases ©ESC 2018
may be harmful.

. . are: (i) to base recommendations on properly conducted studies,
Table 2 ESC Levels of evidence . . . . . . . . . identified from an extensive review of the literature; (ii) to give the

highest priority to data from randomized controlled trials (RCTs);
(iii) to also consider well-conducted meta-analyses of RCTs as strong

not consider to have the same level of evidence because many of the
. . . . . . . . . . . . . . . . evidence (this contrasts with network meta-analyses, which we do
comparisons are non-randomized); (iv) to recognize that RCTs can-
not address many important questions related to the diagnosis, risk
stratification, and treatment of hypertension, which can be addressed

calibre; (v) to grade the level of scientific evidence and the strength of
. . . . . . . . . . . . . . . . by observational or registry-based studies of appropriate scientific
recommendations according to ESC recommendations (see section
1); (vi) to recognize that opinions may differ on key recommenda-
tions, which are resolved by voting; and (vii) to recognize that there

that the question is important for clinical practice and cannot be
ignored. In these circumstances, we resort to pragmatic expert opin-
These 2018 ESC/ESH Guidelines for the management of arterial . . . . . . . . . are circumstances in which there is inadequate or no evidence, but
hypertension are designed for adults with hypertension, i.e. aged >_18 . . . . ion and endeavour to explain its rationale.
years. The purpose of the review and update of these Guidelines was . . . Each member of the Task Force was assigned specific writing tasks,
to evaluate and incorporate new evidence into the Guideline recom- . . . which were reviewed by section co-ordinators and then by the two
mendations. The specific aims of these Guidelines were to produce . . . chairs, one appointed by the ESC and the other by the ESH. The text
pragmatic recommendations to improve the detection and treatment . . . was developed over approximately 24 months, during which the
of hypertension, and to improve the poor rates of BP control by pro- . . . Task Force members met collectively and corresponded intensively
moting simple and effective treatment strategies. . . . with one another between meetings. Before publication, the docu-
These joint 2018 Guidelines follow the same principles upon . . . ment was reviewed by European reviewers selected by the ESC and
which a series of hypertension Guidelines were jointly issued by the . . . ESH, and by representatives of ESC National Cardiac Societies and
two societies in 2003, 2007, and 2013. These fundamental principles . . . ESH National Hypertension Societies.

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