Six years ago, the Egyptian Hypertension Society produced its first guidelines for the management of hypertension. The success and popularity of this report were remarkable and it was in great demand. Since its publication in 1996, several guidelines for the management of hypertension were published. Many of these were recent revisions and updated versions of old ones that were modified according to new evidence from clinical trials. Research in the last decade provided an answer to many clinical questions. Now it is clear that isolated systolic hypertension in the elderly is dangerous and should be treated and that aggressive lowering of blood pressure is required in diabetic hypertensives.
The optimal target blood pressure which should be achieved to obtain the best clinical outcome has been defined in many clinical situations. Blood pressure alone, unless very high, was a poor predictor of cardiovascular risk and the prognosis in hypertensive patients is influenced by other cardiovascular risk factors. Simple dietary interventions like providing plenty of fresh fruits and vegetables and limiting fat and dairy products can lower blood pressure even without decreasing body weight or limiting salt intake (DASH diet). There is accumulating new evidence supporting the favorable effect of the new classes of antihypertensive drugs on morbidity and mortality in hypertensive patients (ACE-inhibitors, calcium channel blockers, angiotensin receptor blockers). However, the recent results of ALLHAT study provide the proof that ACE-inhibitors, calcium channel blockers were equally effective as thiazide diuretics and on the contrary, thiazides were superior as first choice drugs regarding cost effectiveness.

The World Hypertension League and the International Society of Hypertension recommended that national hypertension societies develop their own guidelines that will adapt to the local circumstances and can be applied by the majority of clinicians in their everyday practice in their individual countries. This new edition of the Egyptian Hypertension Society guidelines took into consideration the cultural, and socioeconomic characteristics of Egyptians and many people in the developing world. In order to cover the wide spectrum of socioeconomic differences in developing countries, two approaches were selected for diagnosis and treatment depending upon the economic situation: the minimal and optimal hypertension care. The Egyptian Guidelines were designed to be user friendly, written in a clear uniform style and in a reasonable concise size. The recommendations in guidelines are based upon the following sources:
1. Egyptian data: (a) Egyptian National Hypertension Project (NHP): This survey defined the prevalence of hypertension, other cardiovascular risk factors and hypertensive complications among Egyptians.
(b) Results of the Egyptian multicenter antihypertensive drug study: The aim of the study was to compare the efficacy and tolerability of the four main antihypertensive groups: diuretics, ACE-inhibitors, beta blockers, and calcium antagonists. (c) The Egyptian physician and patient survey: The objectives of this survey were to identify physician and patient’s attitudes and knowledge regarding hypertension, and reasons for non-compliance to therapy.
2. International literature, mainly the results of the recent randomized controlled studies.
3. Other national and international guidelines, the complete reports of the American JNC VI and JNC VII, British Hypertension Society Guidelines, Canadian Guidelines, WHO/ISH Guidelines, Japanese and South African Guidelines.

These guidelines were made through collaborative work of the twenty one members of the Egyptian Hypertension Society working group, whom I thank for their contribution. I would like to acknowledge the effort made by
Dr. Karim Said, who made an outstanding job in helping me in the final editing of the guidelines manual. Also, I should mention the excellent secretarial work of Mrs. Rehab Mohamed. Finally, the support and generous grant offered by Aventis Egypt that helped in the production of this manual should be recognized.

METHOD OF PREPARATION OF THE GUIDELINES

Four specialized subgroups were formed in November 2001. Each subgroup was assigned to write a number of chapters and was chaired by a moderator section editor who represented the subgroup in the writing committee. Every author was asked to prepare a manuscript on the assigned subject. The guidelines working group met on several occasions discussing the contents of the individual chapters, reviewing literature and approving the writing policy. The preliminary guidelines were based upon the completed manuscripts. A pre-final document was prepared for discussion at the meeting held in Luxor during the period 6-9 December 2002. During this meeting each moderator read his assigned section to all the members of the working group, and then each subgroup revised separately the pre-final document. In a second plenary session, remarks, questions, comments and objections were discussed. Whenever there were points of disagreement, voting was applied and decisions were based upon majority approval. The pre-final document for each section was modified accordingly and was sent to the writing committee for the preparation of the final document.

When preparing the guidelines, authors were instructed that these guidelines are for the practicing physicians and not for the consultants, and should be written in a simple and clear language. Any important statements in guidelines should be supported, whenever possible, by evidence from literature.