New ISH President 2012-2014
Read a welcome message from the new Society President - Ernesto Schiffrin (Department of Medicine, Sir Mortimer B. Davis – Jewish General Hospital, McGill University, Montreal, PQ, Canada)
As I start my two-year term as President of the International Society of Hypertension (ISH), I am glad to have the opportunity to express some of my thoughts about the present and future of ISH and hypertension.
We know from numerous studies the huge burden of disease and death that high blood pressure inflicts on populations in the developed world, but the World Health Organization has indicated recently that chronic disease and hypertension have become huge healthcare problems in the developing world as well, in low and middle-income countries. This is in part the result of the adoption of westernized culture and habits in many of these countries, another expression, in this case not a good one, of globalization.
ISH has responded to these developments with changes in the way it operates and in its priorities. On the one hand, an effort was made to enlarge world representation within the ISH Council, to bring in the voice of different regions that did not get representatives elected to Council by naming ad hoc individuals to sit in Council together with elected members. This already allowed a more global approach to issues related to high blood pressure.
Secondly, in the last few years, the financial basis of the Society has been rendered more solid thanks to the efforts of past ISH Presidents Lars Lindholm and Tony Heagerty. This has allowed the Immediate Past President of ISH, Stephen Harrap, to create five Regional Advisory Groups (RAGs), one each of different regions of the world (1) Africa; (2) Latin America; (3) Asia-Pacific; (4) Eastern Europe and Middle East; and (5) North America and Western Europe. These RAGs have been charged with supporting ISH activities across these areas in interaction with regional organizations. In Africa, Robert Fagard’s continued ISH-supported educational activities are now inscribed within this framework.
The Latin American RAG has supported the collaboration of two regional organizations, the Inter-American Society of Hypertension (IASH) and the Latin American Society of Hypertension (LASH), and the recent Hypertension Summer School in Salta, Argentina, and LASH/IASH/Brazilian Society of Hypertension meeting in Porto Alegre, Brazil, as well as workshops on hypertension in Paraguay. There remain to be organized other activities in order to extend educational meetings to Central America.
In other areas of the world, the profile of ISH has also been increased by presence of members of the ISH Council or Executive, or ordinary members, as Teaching Faculty members at various meetings in China and other countries.
Although these activities across the world already consume quite a lot of time of members of the Society, it will be necessary to ensure that ISH participates in the near future in other efforts beyond the educational and scientific meetings that are scheduled to occur in the next few months and years. I believe that ISH needs to become an active participant in the battle to enhance prevention of hypertension and cardiovascular disease in collaboration with the World Hypertension League (WHL) as well as other international or regional and national organizations. This means becoming active in lobbying in favour of efforts directed at lowering sodium intake in populations, enhancing healthy eating habits, exercise and weight control, and combatting smoking.
ISH needs as well to become active in publicizing the requirement for a more rigorous approach to diagnosis of blood pressure elevation. It is indispensable to provide guidance regarding techniques for blood pressure measurement, and insist on the fact that we need to recognize that blood pressure measured in different settings may result in different thresholds for diagnosis of hypertension and different goals for treatment. Although this may appear at first confusing, it has become increasingly apparent from work by several groups that 140/90 mmHg measured manually in a busy clinic is not equal to 140/90 mmHg measured with a research quality technique. With the increasing appreciation that there is indeed a
J-curve, and that very low blood pressures are deleterious for some groups of patients, it is important for us to become advocates of accurate measurement of blood pressure to ensure that neither over nor under-treatment of high blood pressure occurs.
With respect to treatment, ISH represents a very heterogeneous community, which includes countries with advanced and comparatively rich healthcare systems, and others that have to subsist within resource poor settings. Diagnostic and treatment guidelines cannot be the same for both types of milieu. Most of the national and international guidelines currently available are designed for the most advanced and wealthy nations. In middle and low-income countries, and particularly in HINARI countries, it is impossible to offer care for hypertension and cardiovascular disease with the same medication and procedures. It is necessary for ISH to be able to contribute in this domain, and facilitate the production of recommendations that will allow these countries to offer the best quality safe care possible compatible with their resources. ISH can be extremely helpful in this area.
Finally, ISH needs to continue to foster knowledge generation and progress in the science of hypertension. Through its biennial meetings, but also its support and the mentoring of young investigators, ISH is already accomplishing in part this objective. However, ways in which these efforts can be further supported and enhanced need to be looked into.
I hope that the Executive and Council of ISH will be able to count with the usual goodwill of members of ISH and their willingness to help carry out many of these activities so that in two years’ time we can look back and say that we have accomplished at least to a degree some of these objectives.
I want to take the opportunity before finishing, on the one hand to welcome new members of ISH to what I believe is a vibrant society committed to helping improve the outcomes of hypertensive subjects throughout the world, and secondly to thank Stephen Harrap for the great job that he has done as President of ISH 2010-2012.
I am sure that for those of you who have been to Sydney, Australia, to the 24th Scientific Meeting of the ISH, it has been an occasion to hear and see extremely interesting and novel presentations on the science of hypertension, and an opportunity to meet and exchange with colleagues from across the world, as well as enjoy the beauty and the warm and friendly welcome of Sydney and Australia and its citizens.
I wish you all well, and look forward to further exchanges through our Newsletter and at scientific meetings where we will make sure that ISH is contributing to improve outcomes for people with hypertension and cardiovascular disease.
Ernesto L. Schiffrin, CM, MD, PhD, FRSC, FRCPC, FACP