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ARRA Investments in Hypertension

Public Health Burden
Hypertension, or high blood pressure, is a leading cause of other forms of cardiovascular disease (CVD) and thus a major contributor to the death of large numbers of Americans. Of the nearly 74 million Americans who have hypertension, 70% are being treated with antihypertensive drugs, but only 45% have their blood pressure under control.1 Hypertension is more common in the elderly but its prevalence is now increasing at an alarming rate in children and young adults because of the recent upsurge in obesity in the entire population

Basic Research
We need to know more about the biological mechanisms of blood pressure control to determine why current antihypertensive drugs do not work for some people, find new drugs to treat hypertension, and learn how to prevent it. ARRA grants include studies to:
  • Identify factors that explain why women are more likely than men to have uncontrolled blood pressure and might lead to potential gender-specific treatments.2
  • Determine whether hypertension gene variants found in recent genome-wide association studies alter functions in kidneys and blood vessels that regulate blood pressure control.3
  • Determine the mechanism linking sleep-disordered breathing (obstructive sleep apnea) to the development of hypertension.4
  • Expand our understanding of how arterial pressure sensors that signal blood pressure information to the brain work in both health and disease.5
  • Assess the role of mitochondrial genes on the susceptibility of individuals with known CVD risk factors to development of CVD, including hypertension.6
  • Determine the influence of inflammatory factors on vascular injury in obese adolescents with hypertension, with the goal of developing therapies to prevent premature CVD.7
Genetic Studies
Hypertension is a multigenic disease, and researchers are trying to identify important genetic subgroups that may further the goal of creating personalized medicine. ARRA grants include studies to:
  • Identify human genetic variations that contribute to age-related differences in blood pressure.8
  • Use existing genetic studies of hypertension to improve understanding of disease risk factors that are common to all racial and ethnic groups and that characterize sub-groups.9
  • Investigate how genetic variations interact with age and obesity in producing blood pressure levels among different racial and ethnic groups; this work may improve identification of individuals with modifiable genetic risk and approaches to prevention and treatment.10
  • Identify genetic variants that contribute to hypertension risk and sequelae in African Americans.11
Determine Optimal Treatment in the Elderly
Hypertension is very common in the people age 70 and older, ranging in prevalence from 63% of non-Hispanic white men to 83% of black women and men. It not only contributes to cardiovascular and kidney disease but also may be a risk factor for cognitive decline. Although studies suggest that maintaining systolic blood pressure (SBP) below 120 mm Hg may be beneficial, the optimal target for SBP has not been determined. ARRA funds will augment a new clinical trial to:    
  • Compare in an elderly population the effects—on CVD, kidney disease, cognitive function, and other outcomes—of controlling SBP to 140 versus 120 mm Hg.12   
Improving Adherence to Hypertension Treatment
Over 100 effective medications are available to treat hypertension, and lifestyle modification, such as the DASH dietary pattern and weight loss, also reduces blood pressure. Morbidity and mortality associated with high blood pressure can be greatly reduced by improving adherence to medication and lifestyle regimens. ARRA grants will:
  • Test three new approaches to improve hypertension treatment that (1) combine home blood pressure monitoring with feedback to patients and their health care providers with patient education,13 (2) monitor medication adherence and blood pressures electronically, using computer-based telecommunication to physicians and electronic health records,14 and (3) enhance a “telehealth” program that uses electronic measurement technology and health system communications to promote medication adherence and support appropriate medication adjustment.15        
  • Determine the effectiveness of a culturally tailored lifestyle modification program for African Americans that includes motivational interviewing and follow-up “booster” sessions.16
  • Measure the effects of an innovative financial incentive program for medical practices to improve adherence to hypertension treatment guidelines.17

  1. NHLBI Fact Book FY 2008
  2. 1R01HL093271-01A1 -- Role of the renin-angiotensin system in sexual dimorphism in the development of hypertension -- Sullivan, Jennifer C (GA)
  3. 1RC2HL101681 -- Mechanistic characterization of genes for hypertension and renal disease -- Jacob, Howard J (WI)
  4. 2R01HL028785-28 -- Organization of Central Sympathetic Pathways -- Guyenet, Patrice (VA)
  5. 1R01HL081819-01A2 -- Neuromechanical Basis of Baroreceptor Function -- Schild, John (IN)
  6. 1R01HL094518-01A1 -- Mitochondrial Associated CVD Susceptibility in Humans and Mice -- Ballinger, Scott (AL)
  7. 1R01HL092030-01A1 -- Inflammation and Injury in Obesity Hypertension in African American Adolescents -- Falkner, Bonita (PA)
  8. 1R01HL089472-01A1 -- Genotypes, Haplotypes, and Blood Pressure Change from Childhood to Adulthood -- Hallman, D. Michael (TX)
  9. 1R01HL094286-01 -- Development of Data Ontologies for Integrating Multi-Center Cardiovascular Studies -- Rao, Dabeeru (MO)
  10. 1R21HL095054-01A1 -- Exploring a New Direction to Gene Discovery for Hypertension in the Large FBPP -- Rao, Dabeeru (MO)
  11. 1RC1HL100245-01 -- Genetics of Hypertension Risk Factors and Sequelae in African Americans -- Sun, Yan (MI)
  12. SPRINTCoordinatingCenter--N01HC95240 (NC)
  13. 1R01HL089402-01A2 -- Pilot Test of a Novel Behavioral Intervention on BP Control in HTN Patients -- Gerin, William (PA)
  14. 3R01HL090965-01A1S1 -- Home Blood Pressure Telemonitoring and Case Management to Control Hypertension -- Margolis, Karen (MN)
  15. 1RC1HL099830-01 -- TeleHealth & Remote Measurement Technologies to Improve Medical Adherence in Hypertension -- Friedman, Robert H (MA)
  16. 1R01HL087301-01A2 -- Practice-Based Trial of Blood Pressure Control in African Americans -- Ogedegbe, Gbenga G (NY)
  17. 3R01HL079173-02S2 -- Financial Incentives to Translate ALLHAT into Practice -- Petersen, Laura A (TX)

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