The year 2023 marks the 20th anniversary of the hypertension guidelines of the European Society of Hypertension (ESH), which were published for the first time in 2003, following a proposal by Professor Alberto Zanchetti (Fig. 1). Professor Zanchetti thought that it was time for Europe to express its view on diagnostic and treatment aspects of this crucially important medical condition rather than referring, as in the past, to guidelines issued by the WHO, with or without the ISH or the scientific societies in the USA. He played a fundamental role in these first guidelines as coordinator of the Writing Committee appointed by the ESH, and this was rewarded by an unexpected large success, which made these guidelines the fifth most widely quoted paper in the world across all research areas and the most quoted in the medical area. ESH offered to share these hypertension guidelines with the European Society of Cardiology (ESC), which accepted after the manuscript had already been completed, without sharing its publication in the ESC Society Journal. Subsequently, the ESH and the ESC enjoyed an equal collaboration, resulting in three further successful and also widely quoted guidelines in 2007, 2013 and 2018 that were published in the official journals of the two Societies, except for a 2009 reappraisal of the 2007 guidelines, which was prompted by new evidence in the hypertension area and prepared only by the ESH. [.]