The NHLBI Legacy in Hypertension Research

The NHLBI Legacy in Hypertension Research


– I’m Mark Creager, president of the American
Heart Association, in Washington D.C. at the opening day of Hypertension 2015, and with me is Dr. Gary
Gibbons, the director of the National Heart,
Lung, and Blood Institute. And Gary delivered the
keynote lecture today, and it really had a lot to
do with the NHLBI’s vision of high blood pressure. And in fact, Gary, high blood
pressure has really been an important research
component of the NHLBI for many, many years. – Absolutely. It’s clearly a core part of our mission, and the NHLBI really has a
proud legacy of excellence in building a research portfolio
over the last 50 years, that has not only enabled
advances in science to greater understanding of the causes of high blood pressure, but it also had a robust agenda
that spanned the spectrum from population science, basic science, clinical science, and
implementation science that has public health impact. I believe a lot of the
advances about the awareness, treatment, control of high blood pressure that’s occurred over
that last 50 years relate to a lot of the efforts of
the NHLBI research portfolio. In conjunction with partners like the American Heart Association, I think this collective
effort’s made a big difference. – And, Gary, you timed the release of the high level information from the SPRINT trial perfectly this week to coincide with these
hypertension meetings. So, thank you for that. (laughs) But as I know, it was data,
safety, and monitoring committee who felt that it was important
to share this information. What’s your impression of
these top line results? – Well, the SPRINT trial was
really, again, part of a legacy of trials that, I
believe, will be landmark in asking and answering
important questions that advance clinical
science and patient care. The SPRINT trial was designed to ask and answer a question related
to the best treatment strategy to prevent complications of hypertension. Specifically, would a treatment strategy that lowers blood pressure to a target of less than 120 millimeters
of mercury be superior in preventing the complications
of hypertension relative to a target of less than
140 millimeters of mercury? This is an area that’s
been some controversy and uncertainty in the
field, and we’re excited that the Data and Safety Monitoring Board recommended an early stoppage to the blood pressure intervention
component of the study, because it became clear in
their careful monitoring of the data, and with
a focus on what’s best for participants, to
stop this intervention, based on the superior benefits related to a more aggressive, intensive management to the target below 120
millimeters of mercury, in which, just based
on the interim results, yielded about a 30% reduction in the primary composite endpoint, inclusive of heart attacks,
strokes, heart failure, and cardiovascular mortality. In addition, notably, there was also almost a 25% reduction in all-cause mortality as well. And based on these findings
and the interim analysis, it was apparent to the DSMB that the overall benefits
exceeded the potential harms, and they recommended the stoppage, and the NHLBI agreed
with that recommendation. They felt it was important
for the participants and the public to be aware
of this important finding. – And it is indeed an important finding, and I would only imagine that translation of these findings, ultimately,
in the clinical practice, is going to save many, many lives. – And, again, I think
this is an opportunity where we have complementary roles between NHLBI and American
Heart Association, that we’ve funded a study that’s asked and answered an important
research question with a relevance to patient
care and public health, and this should provide data
that informs the process of clinical practice guideline development by organizations such as the AHA, and we look forward to this
information being translated into guidance for clinicians. – The importance of
research done at this level. – Absolutely. – Gary, you’ve spent so
much of your career dealing with hypertension in
health care inequities. I know that’s an important component of the plan of the NHLBI
going forward as well. – Well, it is certainly
one of the elements of our priorities, recognizing that our mission is to enhance the health of the nation, and by so doing, we wanna be inclusive of the full diversity of our nation, and we recognize that not all segments of our population benefited from some of the new knowledge
that has been generated and the efficacy of the clinical
trials that we produced. And so, we wanna be sure
that we have a portfolio that benefits all
communities, and particularly, as you know, there’s a
high burden of hypertension in particular among certain
racial ethnic groups, and this provides both a
challenge and an opportunity to really have a spectrum
of research activities and understand the ideologic
basis of those findings, of how much of that is biological, how much of the complications that appear to be more prevalent relate to things like differences
in genetic variation. We’ve talked about the APOL1 variant, more common in African Americans. It appears to predispose
to chronic kidney disease, as just one example. And similarly, how we might be able to develop new strategies that
work in real world practice and in communities, to enhance awareness, treatment, and control in
those high-risk communities, so this is something
that is a high priority. I think it aligns very well with the American Heart
Association agenda as well, in which we share a common interest in making a difference
on health disparities. – That is so true, Gary, and we can only imagine
the research opportunities that the NHLBI will offer to our scientists. – Absolutely. I think, again, it’s a great opportunity for the collaborative
partnership we’ve shared with the American Heart Association, and I think some of it’s almost emblematic of the initiative AHA has had in the CVGPS realm, in which you’re expanding
to precision medicine across a lot of different cohorts, and we’re very pleased that
there’s been an opportunity for AHA and NHLBI
investigators to work together, particularly on the NHLBI cohorts, Jackson Heart Study and
the Framingham Heart Study to, again, advance the field. – Well, thank you, Gary. We are off to a terrific
start here in Washington D.C. Hypertension 2015 is just under way, and I can anticipate a terrific meeting. Gary, thank you for joining us. – It’s my pleasure to be here.