Division of Cardiovascular Diseases Strategic Plan

Goals in Cardiovascular Clinical Problems or Disease States

2.2b. Develop and validate new strategies to prevent target organ damage in hypertension

Table of Contents

• Overview
• Strategies to Accomplish This Goal May Entail
  • Basic Research
  • Translational Research
  • Clinical Research
• Contributing Sources

Return to Goals in Cardiovascular Clinical Problems or Disease States
Return to Goals of the Division of Cardiovascular Diseases Strategic Plan

Overview

At least 72 million Americans have hypertension, and this number is continuing to increase. Hypertension damages the vasculature throughout the body but morbidity and mortality are generally caused by damage to one or a combination of three organs: the heart, the brain, and the kidneys. Hypertension precedes the development of heart failure in the majority of cases. Hypertension is present in 69 percent of individuals who suffer their first myocardial infarction (MI) and in 77 percent of individuals who suffer their first stroke. Hypertension and diabetes combined are the strongest predictors of end stage renal disease. Current concepts emphasize the direct relationship between elevated systolic pressure and vascular damage. However, blood pressure control, defined as systolic/diastolic pressures below 140/90 mmHg in resting subjects in a clinical examination setting, is achieved in only about half of the treated hypertensive patients. It is crucial to identify and validate early markers of target organ damage as a new strategy to assess effectiveness of blood pressure control and, thus, adjust treatment to prevent and possibly reverse target organ damage. Furthermore, prevention of hypertension alone could be the most effective and efficient approach to reducing the resulting organ damage and CV disease.

Strategies to Accomplish this Goal May Entail:

Basic Research:

• Elucidate fundamental mechanisms of disordered blood pressure control that results in hypertension.
• Elucidate the role of risk factors such as specific nutrients, obesity, insulin resistance, physical inactivity, dyslipidemia, and renal disease in the development of hypertension.
• Investigate biological mechanisms underlying target organ damage to provide targets for novel treatment strategies.
• Identify biomarkers of preclinical target organ damage for preemptive intervention.
• Develop animal models that better mimic human conditions.

Translational Research:

• Test and validate biomarkers, individually and in combination, in animal models and in small clinical pilot studies.
• Identify genetic, epigenetic, and environmental susceptibilities to predict and prevent hypertension and associated target organ damage.
• Identify and elucidate the contribution of new environmental factors to high blood pressure and associated target organ damage.

Clinical Research:

• Compare standard clinical (i.e., office) versus in-home blood pressure monitoring to assess effectiveness of control and onset/progression of target organ damage.
• Test and validate biomarkers of preclinical target organ damage and enhanced blood pressure monitoring (i.e., frequent home monitoring) in clinical trials.
• Test new prevention strategies for hypertension.
• Test new pharmacologic hypertension treatments and lifestyle strategies in clinical trials. for prevention of target organ damage.

Contributing Sources:

• NHLBI Strategic Plan Goals 1 and 2
• Recommendations from the NHLBI Strategic Plan Level One Final Reports:
  • Vascular Diseases and Hypertension
  • Emerging and Evolving Technologies
  • From Discovery to Clinical Applications
  • Personalized Medicine Planning
• Inadequate control of hypertension in U.S. adults with cardiovascular disease comorbidities in 2003-2004.
• Arch Intern Med 167: 2431-2436, 2007

September 2008