DEVELOPMENT OF THE EUROPEAN SOCIETY OF HYPERTENSION GUIDELINES FOR THE MANAGEMENT OF ARTERIAL HYPERTENSION AS SHOWN BY THE CERTAINTY INDEX

Objective: Over the last decade, the European Society of Hypertension (ESH) published several guidelines (GLs) for the Management of Arterial Hypertension in recent years (2013, 2018, and 2023). We hypothesized that the GL has been improved because of the publications of new evidence. Thus, we aimed to examine the development of ESH Guidelines (ESH GLs) by comparing their helpfulness regarding the diagnosis and treatment of hypertension. Design and method: A novel mathematical analysis was used to compare ESH GLs. Not only the frequency of Classes of Recommendations (CLASS) and the Levels of Evidence (LEVEL) were examined but a newly developed Certainty Index (CI) was calculated. This CI allows the CLASS and LEVEL to be assessed together, providing a less biased assessment of GLs, than examining the CLASS and LEVEL independently or related to each other. Results: The number of Recommendations showed continuous and significant increases from 2013 (N=110) to 2018 (N=169), and 2023 (N=269). Examining the frequency of CLASS and/or LEVEL led to biased results, showing both improvements and/or worsening comparing years. However, based on the new analysis, a continuous improvement was shown in the percentage of Certainty from 2013 to 2023 (2013: 60.5%, 2018: 72.1%, 2023: 75.3%). Accordingly, the Certainty Index was also significantly increased from 2013 (CI: 0.21), to 2018 (CI: 0.44) and to 2023 (CI: 0.51). Conclusions: The analysis shows that compared to previous GLs, the structure of the 2023 ESH GL has been rearranged and simplified. The higher number of Recommendations indicates a continuously accumulating knowledge regarding the mechanisms, clinical findings, and epidemiology of hypertension. Moreover, the 2023 ESH GL shows a higher degree of Certainty and Certainty Index, corresponding to a higher level of helpfulness of the 2023 ESH GL for healthcare professionals to diagnose, prevent, and treat hypertension.