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OUR MISSION: TO REDUCE THE BURDEN OF CARDIOVASCULAR DISEASE
I am writing this introduction to this month’s newsletter as I return from a very successful hypertension conference in Naples, organised by our Hypertension Council Vice-Chairman Gianni de Simone and endorsed by the ESC Council on Hypertension. There is more about this outstanding conference later in this newsletter. On the subject of conferences, we have just completed the Hypertension program for the next ESC Congress in Barcelona which will take place at the end of August. It promises to be an outstanding congress and we received a very large number of outstanding abstracts on hypertension for presentation at the meeting. Some of the highlights of the Hypertension program are discussed below.
The Hypertension Council continues to grow its membership and it is exciting to see that our membership is now approaching 1,000, with wide representation across Europe and beyond. It is also reassuring to see so many younger clinicians and scientists joining the council as they are the future leaders. With regard to leadership, the Council recently advertised for applications for 2 vacant positions on the Council nucleus. We received a good number of excellent candidates and you will soon receive information about details of the candidates and when and how you can vote for the new nucleus members.
By the time you receive this, World Hypertension Day (17th May) will almost be upon us. This is an important reminder of the huge burden of hypertension on public health, accounting for more than 10 million deaths globally. It is a sober reminder that there is still much work to be done to improve the detection, treatment and control of blood pressure across the world. This year, the whole month of May has been termed “May Measurement Month” by the International Society of Hypertension and they have embarked on a campaign to try and get blood pressure measured in 25 million people globally.
Finally, it is now 50 years since the publication of a key randomised controlled trial of the treatment of hypertension, the Veteran’s administration study, published in JAMA in 1967. I am surprised that the 50th anniversary of this ground-breaking publication that provided the impetus for treatment of high blood pressure, has not yet received the recognition it deserves. The ESC Council on Hypertension salutes these pioneers, whose work provided the impetus for global hypertension treatment, that has almost certainly saved more lives than any other health care innovation in the past 50 years – see below.
The three days of the Symposium “From Arterial Hypertension to Heart Disease” in Naples, Italy collected outstanding scientists from all over the world, including members of the Nucleus of the ESC Council on Hypertension, discussing mechanistic aspects, natural history, progression, and treatment perspective of arterial hypertension, and proposing an impressive brainstorm. Important highlights have been underlined with recommendations to the Task Force discussing the new European Guidelines that will be released on 2018. Among them, the sessions on target organ damage (including a lecture on dementia), on sex-differences, and on target blood pressure value, in the light of new findings from clinical trials and observational studies on epidemiological scale, have been particularly appreciated and raised animated discussions.
All the lectures will be shortly available on the International Menarini Foundation web-site. The format of the Symposium has been extremely successful and the Council is considering using this format as the template for compact and focused annual meetings with international experts.
Hypertension has a strong presence at the ESC Congress in Barcelona. The sessions are divided into components; (i) themed Educational sessions, and (ii) the abstract sessions.
The themed educational sessions comprise presentations by leading international experts and the topics include arrhythmias in hypertension; hypertension and heart failure; the hypertensive heart; blood pressure measurement; blood pressure and the brain; hypertension urgencies and emergencies, hypertension due to cancer therapies; secondary hypertension; horizon scanning new treatments for hypertension - including new devices, a hot debate on optimal blood pressure targets, a review of the hot papers in the past year and clinical practice sessions dealing with clinical challenges and conundrums in the management of hypertension is a variety of clinical scenarios.
The Abstract sessions are an important part of the Congress because this is where the new clinical science is presented, often by young investigators. We received 420 abstracts for the Hypertension sessions at ESC Barcelona 2017. We were able to select 176 for oral or poster presentations. So, this was a competitive year and all of the abstracts selected are of the highest quality. A special feature of the abstract sessions is the “Advances in sessions” for the highest scoring abstracts. These sessions have been themed and include an opening commentary and a closing perspectives lectures by leading experts in the field.
I am very excited about the quality and clinical importance of the Hypertension program for the ESC Congress in Barcelona and we hope to see as many of you as possible at the meeting.
We recently announced the opportunity for members to apply for new positions on the nucleus of the Council. The application process is now closed and an impressive list of candidates have put themselves forward which is excellent news for the future of the Council. An independent nominations committee will now review and validate the applications and then inform the Council of the final list of candidates for the election of the new nucleus members by the votes of the membership of the Council. It is expected that the list of candidates will be announced very soon and the electronic vote will take place from 1 to 15 June. This is a completely transparent and democratic process, conducted at arms-length from the Council. The outcome is for the members to decide. We will be providing further details in the near future.
In addition to the 2 new nucleus members, the Council also asked for expressions of interest in a new ex-officio position on the nucleus, targeted at younger members of the Council (under 40 yrs) to focus on developing the Council’s online media presence and content, including social media. This position is appointed by the nucleus without election as it is an ex-officio position on the nucleus.
World Hypertension Day is held every year to highlight the enormous health burden associated with hypertension. It is estimated that more than 10 million deaths per year are due to high blood pressure, principally due to heart disease and stroke. Presently less than 50% of the world’s population are aware of their hypertension and less than 50% of those treated are controlled. This means that less than 15% of all people with hypertension across the world are controlled. This is an enormous opportunity missed. To address this, this year’s theme for World Hypertension Day is “know your numbers” and the month of May has been designated May Measurement Month by the World Hypertension League and the International Society of hypertension. The ambition is to get blood pressure measured in 25 million people who have not had their blood pressure measured in the previous year.
The Veteran’s Administration study published its landmark study on the effectiveness of antihypertensive treatment in JAMA on December 11th 1967. To my knowledge this was the first double blind, randomised controlled trial. This was an extraordinary study of just 143 men, mean age ~50years, with clinic diastolic blood pressures ranging from 115 – 129mmHg. They were randomly assigned to treatment with either hydrochlorthiazide plus reserpine plus hydrallazine as required, or placebo treatment, for a duration of 24 months. Blood pressure was reduced by approximately 43/30mmHg in the treated group. At the end of the study there were 27 severe complicating events in the placebo group (which included death) and only 2 in the treated group.
The result was unequivocal and the authors concluded that
"the evidence in this report leaves little doubt as to the value of antihypertensive drug therapy…".
"the evidence in this report leaves little doubt as to the value of antihypertensive drug therapy…".
There is also no doubt that this result provided substantial impetus for major drug development programmes and a focus for public health policy and guidelines to detect and treat hypertension. To use the phrase of these pioneers in antihypertensive drug therapy, there is little doubt that their work provided the foundation for international efforts to save many millions of lives over the subsequent years – that is their legacy. It is also worth reflecting on the fact that 50 years on, there is still much to be done to deliver effective lifestyle advice and drug therapy to many many more who don’t know they have hypertension, have not been treated when they do know, or not controlled when treated.
With best wishes,
Professor Bryan WilliamsChairman of the ESC Council on Hypertension2016-2018
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