Hypertension guidelines: more challenges highlighted by Europe

The release of a new set of major international guidelines from an authoritative group commissioned jointly by the European Society of Cardiology and the European Society of Hypertension (ESH/ESC guidelines)1 is cause for reflection both on the changing scene in hypertension and on the application of guidelines to improve outcomes in people with hypertension in their community. At 76 pages long and supported by 735 references, this is a useful resource, but the question is: to whom? Guidelines should enable practitioners to follow best practice, establish standards of care, and provide balance in the face of many and varied influences experienced by busy clinicians. If it is the purpose of guidelines to enable practitioners, especially those at the front line of patient care, to follow best practice guided by the best available evidence, then these are too long and discursive to be used for everyday practice. A pocket guide is likely to become available in due course and clinicians might use this in their practice if it is user-friendly and can be easily found among the multitude of other disease-based guidelines made available to them.