The Present and Future of the American Society of Hypertension—2012

The American Society of Hypertension (ASH) is entering its 28th year as I commence my term (2012–2014) as president, and it is a characteristic time to review our present status and accomplishments as well as our future initiatives and goals for continued success as the leading US professional organization in hypertension and its related complications. After spending 27 years as a member and now fellow of the Society, several years as a member of the board of directors of ASH, and 2 years as program chair of our annual Scientific Meeting and Exposition, I feel that it is important to (1) evaluate our unique, premier scientific meeting that showcases state‐of‐the art lectures and discussions in our field, (2) assess our relevance to clinical medicine through our members and specialist’s program, (3) review our role in education of physicians and other health care providers, and (4) forecast our potential to support new investigators and clinical and translational research in hypertension and related disorders.

Our Annual Scientific Meeting and Exposition

During the presidencies of Drs Henry Black and George Bakris, ¹ , ² we have witnessed an important paradigm shift in the overall content and format of our Annual Meeting. Before this time, the meetings were routinely excellent in scientific content and based on translational and clinical science in hypertension. Subsequently, we have observed a variety of carefully engineered changes—most are intentional while some, frankly, have occurred outside of anyone’s control. Hypertension as a clinical entity remains one of the most common reasons that adult patients seek medical attention. Thus, it will remain important for specialists in hypertension to train students, housestaff, and fellows in the proper evaluation and treatment of high blood pressure.

Hypertension can no longer be viewed as a clinical or scientific entity in isolation, however, and the leadership of the Society has been (and will continue) expanding the content of the annual meeting to include prominent comorbidities such as diabetes, dysautonomia, dyslipidemia, heart and renal disease, and obesity. This decision has led to partnerships with other professional societies in which successful joint symposia have been held—both at ASH and at the meetings of our partners. Some important examples include the American Heart Association, the European Hypertension Society, the International Society of Hypertension in Blacks, the National Lipid Association, the National Kidney Foundation, the Preventive Cardiology Nurse Association, and the American Society of Nephrology. In addition, specific sessions are now being held at the ASH annual meeting in broader areas of vascular medicine, including anticoagulation, arrhythmias, congestive heart failure, type 2 diabetes, and cardiovascular effects of noncardiac drugs. Since these additional themes have been in place at our meeting, members and attendees can obtain new knowledge in a variety of areas that are important to their continuing education as well as their specialized practices. The feedback has been rewarding over the past several years, and I hope it will continue to be positive.

Another major change in the annual meeting has been changes in sponsorship by industry. Through an outstanding and organized continuing medical education committee, ASH had been successful in maintaining a firewall related to industry sponsorship and overall meeting content; however, we have witnessed a dramatic reduction in antihypertensive drug development and likewise a dramatic reduction in industry support, both in dollars and in abstract submissions. Some members and attendees might find this appealing conceptually, but there is undoubtedly a negative side to this development as ASH (and most other professional societies) has struggled to maintain a strong scientific program on a much leaner budget. Our program committees and staff at ASH headquarters have been extraordinarily effective in this regard, and I am indebted to our co‐chairs in particular over the past 2 years in which I have served as program chair. The levels of scientific and clinical interest and knowledge transferred at our annual meetings have risen to a new peak that we believe will continue as we have set out to diversify both topics and faculty while maintaining our core educational values as the voice of hypertension for both professional and public good.

Membership

The ASH membership fell quite dramatically 6 years ago and has never truly recuperated to levels of the mid‐late 1990s and early 2000s. While our membership roster has been stable during the past 3 years, this is an area of substantial concern to the ASH leadership. ASH officers and the board of directors have scrutinized our inability to attract young physicians and scientists to participate in ASH as we recall doing so ourselves decades ago. We recognize that part of this issue relates to a smaller cohort of physicians entering into or remaining in academic medicine, but additionally, the board and Membership Committee also realize that the Society must offer products of value to our membership; some of this is the scientific and educational product, but, in reality, we also must protect our assets via continued lobbying for clinical recognition. Furthermore, present members should educate potential members about the importance of our Society, what it does, and how it has positively changed during the past 6 years.

There is an undeniable benefit of having trained hypertension specialists to manage patients in both academic and community practices. The hypertension specialty faculty at the Medical University of South Carolina in Charleston, through the establishment and implementation of the ASH Hypertension Patient Registry, has demonstrated both improved hypertension control and containment of costs when physicians in practice are properly trained to manage hypertension based on the latest evidence. ³ Although this work is known to those on the ASH board of directors and other senior members, it is of tremendous importance to expand this endeavor to other areas of the United States to demonstrate the effectiveness of hypertension specialists in improving blood pressure control and outcomes, both clinical and financial. Dr Brent Egan, who has been a leader in ascertaining the impact of educating physicians in the community on treatment goals in patients with hypertension and related comorbidities, has recently become the president of the ASH Specialist’s Program. Together, ASH and the ASH Specialist’s Program will need to work effectively together to make sure that recognition of the attributes of hypertension specialists occur more broadly in the United States.

Finally, through a major effort by senior leaders of ASH, we witnessed the development and approval of a new taxonomy code for hypertension specialists in October 2011. It is hoped that this important milestone will translate during the next few years into a greater recognition of ASH‐certified hypertension specialists by insurers that, in turn, could enhance interest in physicians becoming members of the Society and later becoming ASH‐designated specialists in clinical hypertension.

Educational Initiatives by the Society

The flagship educational program of ASH has always been the annual Scientific Meeting and Exposition described previously. The Society has recently created a formal education committee directed by Dr Alan Gradman ⁴ that has been active this past year in planning a variety of new educational programs and initiatives for implementation in 2012 through 2014. These range from a comprehensive immersion clinical hypertension update course oriented for practicing physicians to a hypertension self‐assessment manual focused on specialists who are in need of updating their knowledge or taking the ASH clinical hypertension designating or re‐designating examination. The Education Committee also has initiatives for programs that may be Web‐based and international in scope. These programs are in their infancy but we hope they will all provide enhanced visibility of ASH as an education‐oriented professional society, attract potential members to consider joining (or rejoining) the Society, and allow busy clinicians unable to attend the annual meeting to obtain ASH high‐quality educational products from their office or within their community.

Programs for Patients and the Community

Since 2008, ASH has developed a unique program in community outreach that is geared towards providing patient and provider education at the grass roots level in conjunction with our annual scientific program. The community outreach program has been successful in supporting itself through external funding and developing collaborative efforts with other professional organizations oriented toward community care. The community outreach program has allowed the expertise of a number of our faculty and senior members to be disseminated to physicians who are involved in primary care in regions with high incident rates of hypertensive disease and in which specialty care may be limited. Since its inception, members of ASH have lectured in community hospitals, spoken to the community, supervised hypertension screening programs, and circulated nutritional information to physicians and other health care providers. The program will continue to provide important community‐based advice to enhance care of patients in medically underserved areas around the United States, and we hope that expansion may occur via ASH‐supervised programs and partnerships with other professional cardiovascular groups. ⁵

The ASH Research Foundation

The leadership of ASH has recently established a foundation with a prestigious group of independent board members to support the directives of the Society. The foundation, to be based in New York, will help in support of the Society’s mission to enhance research and education in our field. It is our hope that the foundation will lay the groundwork for funding initiatives that will enhance the work of the Society in the future. For example, if successful at attracting donors and raising unrestricted funds for the ASH Research Foundation, formal mechanisms to fund post‐doctoral fellowships and research funding through the Society could be realized, an area that we have previously hoped for but have not been able to financially support.

Conclusions

ASH remains the largest professional organization in the United States devoted to hypertension and its consequences. We have seen a number of positive changes in the Society during the past several years but have many challenges that lie ahead. Our greatest challenge at this time is the need to enhance Society membership to carry forward the mission of our founders and senior members. I believe that our educational programs are second to none and help our members to maintain the highest quality possible in their profession—a service that has been a key attribute of ASH for nearly 30 years. Success of the other ASH programs mentioned in this message will require a major effort by our officers and board members, our committees, and subcommittees, as well as our members at large. I look forward to the next 2 years serving the Society as president and hope that in addition to ASH endeavoring to provide benefits to our members, that members will likewise participate in the programs that the Society is offering to allow ASH to grow and flourish in the years to come.