Establishing Funding Priorities for Hypertension Research
A Modest Proposal
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
For more than a half century, the National Institutes of Health (NIH) has funded both basic and clinical/translational research that has contributed to an improved understanding of the pathophysiology of hypertension and to the development and implementation of approaches for hypertension prevention and treatment. Milestones in hypertension research over the past century, many of which were based on NIH support, have recently been reviewed.1 These initiatives have undoubtedly been a factor in the improved hypertension control rates and the reduction of hypertension-related cardiovascular disease and stroke mortality since the 1960s. Between 1999 and 2015, in the United States, age-adjusted cardiovascular disease mortality decreased by 43% (287.0 per 100 000 in 1999 and 162.7 in 2015).2 Stroke mortality also decreased by 43% (50.7 in 1999 and 28.6 in 2015).
Nevertheless, hypertension remains a formidable public health problem. Worldwide, the prevalence of hypertension is estimated to be 32%, totaling ≈1 billion people, and hypertension is the leading cause of death.3 In the United States between 1999 and 2014, the age-adjusted prevalence of hypertension has increased from ≈29% to 34% (from >75 to >85 million people), although hypertension control rates have increased from 32% to 54% during that time period.3–5 To achieve blood pressure control, most patients require ≥2 antihypertensive drugs.6 Cardiovascular diseases, including heart disease, hypertension, heart failure, and stroke, continue to be leading causes of death in the United States.3 In the United States, hypertension affects 46% of patients with cardiovascular disease and 72% of those who have had a stroke.7 Overall, hypertension contributes to 19% of total US mortality, and in 2014, >400 000 deaths included high blood pressure as a primary or contributing cause.3 Cardiac failure, including diastolic dysfunction with normal systolic function, is among the most common causes …