Building on a Legacy of Hypertension Research

In partnership with other public and private funders of biomedical research, the National Heart, Lung, and Blood Institute (NHLBI) has pursued its mission to provide global leadership in research that advances the prevention, treatment, and control of hypertension over the last half century. Since its founding in 1948, NHLBI has fostered investigatorand institute-initiated research in hypertension that encompassed studies in basic, translational, clinical, and population science research. In fact, 60% of the overall National Institutes of Health investment in hypertension research, by dollar amount of funding or by number of grants, comes through the NHLBI, followed by the National Institute of Digestive Disorders and Kidney (15%). These many research advances have ushered in a wide spectrum of safe and effective interventions for the prevention, detection, evaluation, treatment, and control of hypertension. In spite of these remarkable achievements, hypertension remains the leading cause of global death and disability from heart disease and stroke and a major contributor to all-cause mortality worldwide. In 2013 alone, high systolic blood pressure accounted for >10 million deaths and 208 million disability-adjusted life years lost globally. In the United States, hypertension continues to play a major role in mortality disparities because of its high prevalence and earlier age of onset in non-Hispanic blacks compared with other race/ethnic groups. Hypertension explains ≈50% of the excess cardiovascular risk among non-Hispanic blacks compared with non-Hispanic whites. These persisting challenges compel a continued commitment to identify effective strategies for the prevention of hypertension-related morbidity, mortality, and disparities. In this endeavor, the NHLBI remains committed to the full spectrum of hypertension research from molecular, genomic, cellular, and pathophysiological origins to the role of important social and environmental determinants and conditions under which people live and work. We support continued exploration of these social determinants and conditions, especially obesity, sedentary lifestyle, sleep-disordered breathing, and dietary factors, such as higher sodium intake and lower potassium intake. Key mechanistic insights and connections remain incompletely understood and constitute ripe opportunities for future hypertension research. For instance, future improvements will critically depend on answering fundamental enduring questions about the relations of hypertension and associated target organ damage, chronic kidney disease, cognitive impairment, and small-vessel cerebral ischemic disease. To translate the latest fundamental discoveries to real-world health impact, the NHLBI seeks to identify and enable the most meritorious research with the firm understanding that all the various types of research are needed to inform each other and is, thus, committed to a balanced overall research portfolio. In this article, we highlight a few NHLBI-supported advances from basic and early translational research, clinical trials, and population science encompassing hypertension research over the prior 50 years and the foundational insights they provide for future research. We also address the NHLBI enduring principles and propose how collectively we can seize unprecedented opportunities to address the challenges we face today by setting the agenda for hypertension research over the coming decade.