Harmonization of the American College of Cardiology/American Heart Association and European Society of Cardiology/European Society of Hypertension Blood Pressure/Hypertension Guidelines
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Why the study?
The 2017 ACC/AHA and 2018 ESC/ESH hypertension clinical practice guidelines have differences in blood pressure cut points for diagnosis and in the timing and intensity of treatment, prompting a comparison to evaluate concordance and potential harmonization.
Key Points
- Compare and evaluate recommendations from the 2017 ACC/AHA and 2018 ESC/ESH clinical practice guidelines for hypertension management to identify areas for international harmonization.
- Assessed guideline development methodologies, evidence review processes, and formal consensus frameworks for the 2017 ACC/AHA and 2018 ESC/ESH documents.
- Analyzed structural similarities and discrepancies regarding blood pressure diagnostic cutoffs, treatment timing, and therapeutic intensity.
- Identified recommended blood pressure cut points for diagnosing hypertension as the principal difference between the guidelines, alongside a more intensive and earlier treatment strategy favored by the ACC/AHA.
- Demonstrated substantial concordance and improved congruity between the two guideline committees relative to earlier iterations, indicating strong potential for global alignment in blood pressure control.
Comparison
2017 ACC/AHA guideline vs 2018 ESC/ESH guideline
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The first thing people usually do with guidelines, and it's kind of a knee-jerk response, is to put them side by side and [ask] what can we find that's different and then make an awful lot out of that: 'The experts can't agree. It's a crisis situation. Patients have no confidence. Clinicians must be confused, etc.'”
“So the accent is placed on differences, but if you look at the similarities, these are much more important.”
“Despite different approaches to guideline development and different healthcare systems, our independent assessments of vast quantities of data have broadly reached similar conclusions.... This can only be a good thing.”
Implication
Clinicians should apply risk-based BP management amid guideline differences; leaves open optimal diagnostic threshold pending harmonized outcome trials.[[1]](https://academic.oup.com/eurheartj/article/43/35/3302/6661233)[[2]](https://www.acc.
Abstract
The 2017 American College of Cardiology/American Heart Association and 2018 European Society of Cardiology/European Society of Hypertension clinical practice guidelines for management of high blood pressure/hypertension are influential documents. Both guidelines are comprehensive, were developed using rigorous processes, and underwent extensive peer review. The most notable difference between the 2 guidelines is the blood pressure cut points recommended for the diagnosis of hypertension. There are also differences in the timing and intensity of treatment, with the American College of Cardiology/American Heart Association guideline recommending a somewhat more intensive approach. Overall, there is substantial concordance in the recommendations provided by the 2 guideline-writing committees, with greater congruity between them than their predecessors. Additional harmonization of future guidelines would help to underscore the commonality of their core recommendations and could serve to catalyze changes in practice that would lead to improved prevention, awareness, treatment, and control of hypertension, worldwide.
Discussion
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Cite This Study
Whelton et al. (2022) studied this question.