1. ASH SPECIALIST PROGRAM REPORT Thomas D. Giles, MD, President of the ASH Specialist Program Inc.,

2. Designated Specialists TOTAL NUMBER OF DESIGNATED SPECIALISTS IN CLINICAL HYPERTENSION: 1,344 –2009 – 101 –2007 – 128 –2005 – 153 –2003 - 176 –2001- 200 –Initially Designated Specialists -- 586

3. CHANGE IN EXAM SCHEDULE HYPERTENSION EXAMINATION TO BE GIVEN ANNUALLY ON COMPUTER AT MULTI SITES DATE AND SITE OF 2010 HYPERTENSION EXAMINATION TO BE SET SHORTLY

4. REDESIGNATION OF PHYSICIANS ORIGINALLY DESIGNATED AS HYPERTENSION SPECIALISTS IN 1999 AND 2000 The ASH Specialist Program has issues new certificates without an expiration date for those physicians originally designated as Hypertension Specialists in 1999 and 2000, without requiring any re-examination or other criteria.

5. ASSOCIATION OF HYPERTENSION SPECIALISTS The ASH Specialists Program Inc. and ASH established the Association of Hypertension Specialists (AHS) as a Special Interest Group within ASH to serve as an advocacy group dedicated to promoting increased recognition for expertise in the diagnosis and treatment of hypertension and providing increased resources for the care of patients with hypertension The AHS held its 1st meeting on May 6, 2009, after the “Hypertension Highlights” Session at the 2009 ASH Annual Scientific Meeting in San Francisco.

6. Initial goals of the Association of Hypertension Specialists (AHS): To obtain a medical specialty code description from CMS to identify a hypertension specialist. To meet with members of the medical insurance industry to negotiate and promote recognition and increased reimbursement for hypertension specialists. To host forums during the annual meeting of the American Society of Hypertension, and at other meetings, to learn of ways to improve the practice of the hypertension specialists, including the incorporation of new technology. To devise brief presentations that may be used by national and local speakers to use when presenting to policy makers, i.e. government, insurance industry, hospital staffs, etc.

7. ASH Specialist Program, Inc. and ASH have launched an initiative to : #1: To have hypertension recognized as a body of knowledge sufficient to be the foundation for a specialist practitioner. #2: To obtain identifier codes for physicians who are Designated Specialists in Clinical Hypertension –Health Care Provider Taxonomy Code-- National Uniform Claim Committee (NUCC) –Health Care Provider Specialty Code for “Hypertension Specialists---(Center for Medicare Management (CMS) #3: To develop and implement criteria to designate and certify hypertension centers, since this is often a pathway utilized by CMSS and other payers to reimburse for certain specialty services

8. HYPERTENSION SPECIALIST Hypertension is a complex illness that varies greatly in severity. Approximately 15% of those with hypertension are difficult to treat (“resistant”). Moreover, approximately 5% of those with hypertension have a secondary (known etiology) form of the disease. There are currently only 1,500 individuals who have become certified as hypertension specialists by passing the examination given by the ASH Specialist Program. Thus, it is apparent that to meet the demand for patient care, many more hypertension specialists will be required. Because of the important role that these hypertension specialists will play in the prevention of cardiovascular and renal disease, it is necessary to describe the characteristics of the speciality in addition to the passage of the examination.

9. HYPERTENSION SPECIALIST II. Criteria to be designated as a Specialist in Clinical Hypertension Degrees (MD or equivalent, DO) Parent Specialty (Internal Medicine, Cardiology, Nephrology, Endocrinology, Family Medicine, Pediatrics, etc) Competent with all modalities for the treatment of HTN Passage of Hypertension Specialist Examination

10. HYPERTENSION SPECIALIST A. Referral source for difficult to manage (“resistant”) hypertension B. Referral source for investigation for secondary causes of hypertension C. Referral source for investigation of White Coat and Masked HTN D. Referral for assessment of global cardiovascular and renal risk using sophisticated techniques III. Clinical Function of Hypertension Specialist (It is expected that a majority (at least 50%) of the clinicians practice will be devoted to care of patients with hypertension and related disorders. E. Serve as community resource for HTN and related disorders, e.g. formulary committees, credentialing committees, training programs, medical insurance companies, outreach programs F. Integrate lifestyle modification in HTN treatment strategies

11. HYPERTENSION CENTERS Hypertension Centers will be accredited at three levels, with Level III being the most complete. One over- arching criterion for accreditation of a Hypertension Center is that the facility will be directed by a physician who has received designation as a Hypertension Specialist by the Hypertension Specialist Program of ASH.

12. HYPERTENSION CENTERS Level I Director must be an ASH Designated Specialist in Clinical Hypertension >50 % of practice devoted to patients with hypertension and related disorders Personnel are certified in recording blood pressure and in maintaining equipment for both the Center and self monitoring for patients. Performs and interprets for 24-hour ambulatory blood pressure recording. Availability for cardiovascular risk assessment including, but not limited to quantitative echocardiography, exercise testing, measurement of arterial compliance, ankle-brachial index Participation in investigator-initiated research and/or in appropriate multi- center trials and observational studies Recognition as referral and treatment resource for resistant hypertensives secondary hypertensives, and alternative therapies. Performs ongoing quality improvement

13. HYPERTENSION CENTERS Level II Level II Centers will be located in either academic medical centers or in large multi-specialty clinics. These centers may exist independently or as part of large division(s). In addition to all of the above criteria, these centers will have the following criteria: Meets Level I criteria Director should hold an academic appointment of Associate Professor or higher Center should have the ability to perform extensive multi-specialty examination and treatment Center should be involved in research, both basic and applied Center should be involved in the training of those interested in hypertension as a specialty Center should be involved in the publication of scholarly articles related to the field of hypertension and related disorders