ESH Hypertension Excellence Centres: A new strategy to combat an old foe
Hypertension has become the number one cause of death in the world according to a WHO‐supported investigation. About one billion people suffer from hypertension, which accounts for about seven million deaths per year. The problem is rapidly worsening and this happens at a time when a large number of very well tolerated and inexpensive antihypertensive drugs have become available. Along with this knowledge, widespread research is therefore being carried out on epidemiology, aetiology and treatment of hypertension. We know that influence on the heart, brain, kidneys and other tissues can be detected early and that hypertension can be successfully treated before established disease breaks out.
The European Society of Hypertension (ESH) is making continuous efforts to manage the burden of hypertension in Europe by stimulating scientific exchange related to knowledge about hypertension, and supporting and building organizations committed to work for the control of hypertension. However, on average, individuals with diagnosed hypertension in Europe appear to have higher blood pressure levels and worse hypertension control than patients in the USA. How best can an opposing coalition of European doctors, scientists and researchers coalesce, and mount a potent counter‐offensive? The answer lies within the latest tactics and strategies of the European Society of Hypertension (ESH).
For some years now, ESH has been striving to streamline and bolster the ability of doctors for this battle by identifying hypertension specialists in European countries and standardizing their skills to the highest level through what it calls the Hypertension Specialist Initiative. The idea was simple: establish criteria for eligibility as a Hypertension Specialist of ESH for doctors interested in this programme, and proceed to certify each candidate through a standardized vetting, which involves cooperation between the ESH and individual national hypertension societies. Under this programme, over 800 Hypertension Specialists of the ESH have been certificated by receiving an ESH Clinical Hypertension Specialist Diploma.
Now that the troops have been and continue to be trained, the next step is deployment throughout the European‐wide battlefield in the most effective way. ESH has recently launched a new initiative to create a unique Pan‐European network of Hypertension Excellence Centres. The main purpose of this network is to provide a stable and organized European platform for the advancement of hypertension prevention and control. By marshalling an array of forces into a vast united front and positioning this strength through a network scattered across the continent, these ESH Centres of Excellence provide the highest level of both inpatient and outpatient hypertension care, including surgical and vascular interventions, and assessment of global cardiovascular risk.
As of April 2007, numerous applications have been submitted to establish ESH Hypertension Excellence Centres, which have been supported by national societies for hypertension. At this time, the ESH Scientific Council has approved 65 centres in the first round of applicants, representing 13 European countries. The list of ESH Hypertension Excellence Centres will be published in the journals endorsed by the ESH (Journal of Hypertension and Blood Pressure). Official certificates will be handed to the heads of these centres during the 17th European Meeting on Hypertension in Milan, 15–19 June 2007.
All ESH Hypertension Excellence Centres have in‐house access to multi‐disciplinary services, such as those provided through cardiology, nephrology, endocrinology, gynaecology, ophthalmology, neurology, urology, intensive care, surgery, vascular surgery, radiology, angiography (including percutaneous transluminal angioplasty with stenting) and clinical chemistry (including special tests for diagnosis of secondary forms of hypertension). All centres have a high number of hypertension‐related hospitalizations and outpatient visits per year.
Excellence Centres have expertise for ambulatory blood pressure monitoring, echocardiography and vascular ultrasound, not to mention the ability to search for secondary hypertension through laboratory tests and imaging procedures (arteriography; renal and adrenal ultrasound, computed tomography, magnetic resonance imaging). The heads of the approved centres have international recognition in hypertension care/research as evaluated by the ESH Scientific Council. Doctors/scientists working in the centre of excellence have appropriate specializations (internal medicine, cardiology, nephrology, endocrinology, angiology, paediatrics, molecular medicine, etc.). Their clinical experience in hypertension management has been documented by having an ESH Clinical Hypertension Specialist diploma.
In summary, the specific tasks for each Hypertension Excellence Centres will be:
To provide the best possible clinical management of patients with high blood pressure;
To set standards in the diagnostics and treatment of hypertension in regions of service;
To evaluate and improve blood pressure control for primary care, specialists and hypertension centres in regions of service;
To offer continuing medical education opportunities focusing on teaching primary‐care physicians in the region of service;
To carry out research (experimental/clinical/epidemiology) represented by papers in peer‐reviewed international as well as in local scientific journals;
To co‐operate with other ESH Hypertension Excellence Centres to increase the understanding concerning the importance of hypertension as a major health risk in Europe;
To co‐operate with the ESH Scientific Council to elaborate new hypertension control strategies in Europe.
We hope that our new initiative will support the need for establishing hypertension as a clearly defined medical specialty with official approval in the EU region.
Victory will not result from complacency, and the ESH Hypertension Centres programme is continuing its recruitment. Applications can be sent to:
Professor Margus Viigimaa
Centre of Cardiology
North Estonia Medical Centre
Sütiste St. 19
Tallinn 13419
Estonia
E‐mail: [email protected]
Applications to become a Centre of Excellence received before 31 December 2007 will be evaluated by the ESH Scientific Council in March 2008.
Margus Viigimaa
Csaba Farsang
Sverre E. Kjeldsen
Krzysztof Narkiewicz
Giuseppe Mancia