research proposal for hypertension

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High Blood Pressure Research

Language switcher.

As part of its broader commitment to research on cardiovascular diseases, the NHLBI leads and supports research and programs on hypertension (high blood pressure). The NHLBI has funded several studies and programs to help develop new treatments for high blood pressure, many of which focus on women’s health, lifestyle interventions, and health disparities. Current studies aim to prevent pregnancy complications and improve blood pressure among people who are at high risk.

NHLBI research that really made a difference

Find  funding opportunities  and  program contacts  for high blood pressure research.

• The Dietary Approaches to Stop Hypertension (DASH) Sodium Trial showed that lowering sodium as part of a healthy eating plan significantly lowers blood pressure for people with high blood pressure. Researchers saw the greatest change when lowering sodium was combined with eating a diet rich in fruits and vegetables and low in saturated fat.
• The NHLBI’s Systolic Blood Pressure Intervention Trial (SPRINT) study found that treating to a lower systolic blood pressure target — less than 120 mm Hg — helped lower deaths from heart attack and stroke, particularly among older people who have high blood pressure. These findings informed the latest high blood pressure guidelines in 2017. A follow-up study called SPRINTMIND found that treating to this lower blood pressure target also reduced mild cognitive impairment , a condition that can lead to dementia.
• The NHLBI Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT ) was the largest hypertension clinical trial ever conducted, involving more than 600 clinics and 42,000 participants. The study compared the effectiveness of three commonly used blood pressure-lowering medicines (a calcium channel blocker, amlodipine; an ACE-inhibitor, lisinopril; and an alpha-receptor blocker, doxazosin) with a diuretic, chlorthalidone. The trial concluded that the diuretic worked better than the other medicines to manage high blood pressure and prevent stroke, as well as some types of heart disease, especially heart failure.

Current research funded by the NHLBI

Our Division of Cardiovascular Sciences and its Vascular Biology and Hypertension Branch oversee much of the research we fund on the regulation of blood pressure. 

Current research on the treatment of high blood pressure

NHLBI-supported research has led to creating and updating blood pressure treatments that have helped people around the world. High blood pressure affects millions of U.S. adults. We continue to support work on new treatments and also new approaches that tailor the right treatment to the right patient.

• Researchers in the NHLBI-funded Levy Lab are studying the role of genetics in cardiovascular disease using resources from the Framingham Heart Study to develop promising blood pressure medicines and treatments.
• The NHLBI funds research into the connection between inflammation and high blood pressure . Better understanding of the causes of hypertension helps researchers develop treatments to improve blood pressure management and prevent early death from cardiovascular disease.
• The NHLBI supports research to improve adherence to long-term cardiovascular medicines that help regulate blood pressure. Researchers use pharmacy data to identify patients who fail to refill their medicines. They then test whether reminders using text messages or interactive chat bots can improve medicine adherence.
• The NHLBI funds research into the connection between the microbiome and high blood pressure . One study found that bacterial strains in the mouth were linked to high blood pressure in older women. Another study showed that intermittent fasting in an animal model could reduce hypertension by reshaping the gut microbiota. 
• Findings from the Offspring Cohort of the Framingham Heart Study (FHS) and the Coronary Artery Risk Development in Young Adults (CARDIA) study showed a close association between hypertension and late-onset epilepsy and other brain changes, respectively, which may increase the risk of cognitive decline later in life.
• A clinical trial called Treating Resistant Hypertension Using Lifestyle Modification to Promote Health (TRIUMPH) showed that lifestyle modification, such as following the DASH eating plan, could significantly reduce blood pressure even in patients with resistant hypertension. Another study found that DASH was effective in adolescents with high blood pressure. 
• A clinical trial Chlorthalidone in Chronic Kidney Disease (CLICK) showed that the diuretic chlorthalidone can improve blood pressure control in patients with advanced chronic kidney disease. 
• A recent meta-analysis showed that use of anti-hypertension medicines that can cross the blood-brain barrier is linked to more cognitive benefits than those that do not cross the barrier. 

Find more NHLBI-funded studies on the  high blood pressure treatment at NIH RePORTER.

Find out more about how the DASH diet and exercise help fight resistant high blood pressure.

Current research on women’s health and high blood pressure

NHLBI-supported research has helped reveal how pregnancy complications, including high blood pressure, affect the long-term health of women and their children.

• One study found that women who have a preterm birth have a greater chance of later developing high blood pressure.
• The NHLBI continues to fund the nuMoM2b Heart Health Study , which helps scientists understand how cardiovascular disease starts and develops in women. Researchers, funded by the NHLBI and the Eunice Kennedy Shriver National Institute of Child Health and Human Development,  found that women who developed complications during their first pregnancy were more likely to have had higher levels of blood sugar, blood pressure, and inflammation during their first trimester than women who did not develop complications. They are also more likely to develop chronic hypertension within 7 years after delivery. The study is also looking at the  links between pregnancy, sleep health, and cardiovascular health .
• The NHLBI’s  CHAP Maternal Follow-up Study is examining the impact of treatment for preeclampsia and high blood pressure during pregnancy on a woman’s future chance for developing cardiovascular disease. The results will help identify the best ways to improve the health of women younger than age 40 who have mild, long-term high blood pressure.

Find more NHLBI-funded studies on  women’s health and high blood pressure at NIH RePORTER. 

Current research on health disparities and high blood pressure

Black adults in the United States have a higher prevalence of high blood pressure than other racial and ethnic groups. The NHLBI supports research to understand and reduce high blood pressure disparities, as part of our broader commitment to addressing  health disparities and inequities .

Other studies and research areas we fund to understand and lower the impacts of health disparities are listed below:

• Our RURAL: Risk Underlying Rural Areas Longitudinal Cohort Study reaches 4,000 young and middle-aged men and women from different racial and ethnic groups living in poor rural counties in four southern states. The goal of the study is to understand what causes the high rates of heart and lung disease in these regions and how to lower those rates and improve prevention efforts .
• Co-funded by the NHLBI  and the NIH Office of Research on Women’s Health, the Maternal Health Community Implementation Program (MH-CIP) supports community-engaged implementation research, working with affected communities to improve heart, lung, blood, and sleep health before, during, and after pregnancy. MH-CIP focuses on bringing effective maternal health interventions — including projects related to hypertension — into communities severely impacted by maternal health disparities.
• An NHLBI-funded study aims to improve implementation of the SPRINT findings in underserved populations. The study puts into practice a plan for blood pressure treatment at 30 clinics that serve people with little or no income in southeast Louisiana.  The study’s findings will help lower barriers to blood pressure treatment faced by people who experience poverty.

Find more NHLBI-funded studies on  high blood pressure and health disparities at NIH RePORTER. 

High blood pressure research labs at the NHLBI

The NHLBI  Division of Intramural Research and its  Cardiovascular Branch conduct research on diseases that affect the heart and blood vessels, including high blood pressure. Other Division of Intramural Research groups, such as the Center for Molecular Medicine and  Systems Biology Center , perform research on heart and vascular diseases.

Related programs

• In 2023, the NHLBI convened the  Transforming Hypertension Diagnosis and Management in the Era of Artificial Intelligence (AI) workshop to discuss gaps and opportunities in leveraging AI technologies for hypertension diagnosis and management.
• Nurse case management, in which a nurse provides behavioral counseling and monitors blood pressure through telehealth, adjusting blood pressure medications as needed 
• Community health workers providing health coaching and information about community resources 

        Read more about the DECIPHeR program .

• In 2019, the NHLBI convened the HIV-associated Comorbidities, Co-infections & Complications Workshop , which led to strategies that support more research into the diseases, infections, and complications related to HIV. People with HIV have a higher risk of developing high blood pressure, even if they actively manage HIV infection with medicine.

Explore more NHLBI research on high blood pressure

The sections above provide you with the highlights of NHLBI-supported research on high blood pressure. You can explore the full list of NHLBI-funded studies on the NIH RePORTER .

To find more studies:

• Type your search words into the  Quick Search  box and press enter. 
• Check  Active Projects  if you want current research.
• Select the  Agencies  arrow, then the  NIH  arrow, then check  NHLBI .

If you want to sort the projects by budget size — from the biggest to the smallest — click on the  FY Total Cost by IC  column heading.

Living with Hypertension: A Qualitative Research

Affiliations.

• 1 Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
• 2 Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
• PMID: 28670584
• PMCID: PMC5478742

Background: Hypertension affects many aspects of the patients' life. Factors such as attitudes, beliefs and experiences, and social and cultural conditions of patients have effective roles in hypertension treatment process. The aim of this research was to explore perspectives and experiences of patients with hypertension while living with this disease.

Methods: This is a qualitative research using content analysis approach. 27 hypertensive patients who referred to hospitals affiliated to Tehran University of Medical Sciences were selected based on purposive sampling, and semi-structured interviews were carried out. Graneheim and Lundman's approach was used for analysis of data and Lincoln and Guba's criteria were used to confirm the trustworthiness of the study's findings.

Results: Experiences of the participants were divided into three main categories as follows: (1) disease shadow; (2) dual understanding of the effect of drug therapy consisting of two sub-categories known as ''perceived benefits,'' ''negative consequences''; and (3) facing the disease that includes the two subcategories of ''Compatibility'' and ''Negligence and denial''.

Conclusion: Based on the findings, patients with hypertension had experienced many physical, psychological, social, familial and spiritual problems due to the disease and their cultural context. These patients obtained positive experiences following the compatibility with hypertension. Comprehensive planning tailored to the cultural, social context and their beliefs is necessary to solve problems in these patients.

Keywords: Qualitative research; Experience; Hypertension.

Research Proposal: Hypertension and Chronic Kidney Disease

Introduction, the link between the two diseases, risk factors, prevention and treatment, reference list.

Chronic kidney disease and hypertension are two serious disorders that are closely connected. This connection has not been fully researched yet. Thus, it has been found that up to 63% of people suffering from chronic kidney disease are hypertensive (López-Novoa, Martínez-Salgado, Rodríguez-Peña & López Hernández, 2010). It is also known that high blood pressure is often “poorly controlled” in patients who undergo hemodialysis (Kauric-Klein, 2013). Nonetheless, researchers have not identified particular risk factors that lead to development of the hypertension in patients with chronic kidney disease and vice versa. Research on treatment and prevention has numerous gaps.

As has been mentioned above, people with chronic kidney disease are prone to hypertension and vice versa. There are a number of works on the link between the two diseases. For instance, Kauric-Klein (2013) notes that cardiovascular disorders account for about 50% of deaths in patients suffering from chronic kidney disease and hypertension is one of major risks of development of cardiovascular diseases. López-Novoa et al. (2010) state that high blood pressure is the second leading cause of development of end-stage renal disease. High blood pressure leads to nephrosclerotic glomerulopathy, which deteriorates proper renal function. At the same time, patients with chronic kidney disease are likely to develop hypertension. Thus, 40% of patients with the second stage of chronic kidney disease have high blood pressure (López-Novoa et al., 2010). It has also been acknowledged that high blood pressure can cause development of mild renal dysfunction that can lead to development of more serious hypertension, which, in its turn, will deteriorate renal function. Clearly, various risk factors contribute to development of the two disorders.

Among risk factors, the most significant are age, nutrition, inappropriate treatment, lifestyle as well as gender and race. It is necessary to add that the combination of two or more risk factors increases the chance of development of the two diseases. Although there are some works on the risk factors, there are numerous gaps in the knowledge. Existing literature on the matter focuses on age though some other factors are also identified. Kauric-Klein (2013) states that age is one of the most significant risk factors as the older people get the higher blood pressure they have and the more deteriorated their renal function becomes. Smart et al. (2013) note that more than 13% of Australians aged over 25 have chronic kidney disease (stages 3-5) while 30% of adults aged over 65 have chronic kidney disease (stages 3-5).

Of course, nutrition plays an important role in preventing or treating hypertension and renal disorders. People who do not control consumption of liquids are at a higher risk of developing a more severe chronic kidney disease. Nutrition is essential in prevention and treatment of the disease. Kauric-Klein (2013) stresses that patients who follow dietary prescriptions are more likely to control their blood pressure and have a more effective chronic kidney disease management.

Race also has certain effect on development of chronic kidney disease and hypertension. Thus, Kauric-Klein (2013) states that race has an impact on the way people control their treatment and nutrition. Thus, it is found that African Americans are characterized by “skipping and shortening” of HD treatments (Kauric-Klein, 2013, p. 978). At this point, it is necessary to note that correlation between race and development of hypertension and chronic kidney disease has not been identified and further research is necessary.

Likewise, gender also has certain effect on the course of the disease. Females tend to be more responsible and control their fluid consumption and follow all the necessary prescriptions (Kauric-Klein, 2013). Again, it is not clear whether gender has a significant impact on development of the disorders. However, when it comes to treatment, the correlation has been identified.

As far as nutrition and life style are concerned, there is quite definite link between them and development of the disorders. People who have inappropriate lifestyles (eat a lot of harmful food, have little exercise and so on) are at a higher risk of development of hypertension and chronic kidney disease.

Prevention and treatment of hypertension and chronic kidney disease are still disputable. López-Novoa et al. (2010) focus on medication, gene and cell therapies. The researchers state that these are the most advanced and effective ways to treat the diseases in question. The authors mention some drugs that have proved to be effective. The pay special attention to potential use of cell and gene therapy. López-Novoa et al. (2010) admit that the latter two types of treatment are still on the stage of development but they stress that there have been many promising findings in the field.

As has been mentioned above, improper nutrition often leads to development of the diseases. Clearly, proper nutrition may be an effective preventive measure as well as an efficient supplementary treatment strategy. It has been acknowledge that control over liquid consumption among patients with chronic kidney disease and hypertension positive affects their health condition.

Finally, proper lifestyle is another important treatment and prevention strategy that can be employed. Smart et al. (2013) note that moderate aerobic exercise has proved to be effective in patients with chronic kidney disease and hypertension. The researchers stress that training should be developed by professionals who take into account all health conditions of the patient. There are also certain contraindications to exercise. For instance, if a patient has electrolyte abnormalities, peripheral oedema and some other disorders, training cannot be assigned. It is also noted that the change of the medication regime as well as certain issues with dialysis treatment can be a contraindication to exercise. Likewise, Howden et al. (2013) note that aerobic exercise can be controversial and it is essential to pay attention to all health conditions of the patient prior to development of a training program. At the same time, the researchers stress that exercise can be seen as an effective treatment and preventive strategy that can be utilized when treating patients with chronic disease and hypertension.

In conclusion, it is possible to note that there is significant amount of works on the link between chronic kidney disease, risk factors causing the diseases as well as treatment and preventive measures. Researchers have identified that there is certain link but there are certain gaps in this sphere. Major risk factors have been pointed out but there is not sufficient evidence as only one risk factor is identified clearly. As for the rest of the risks identified (gender, race, lifestyle, dietary habits), there are quite controversial data and, hence further research is needed. Finally, treatment and prevention measures have received considerable attention in the literature, however, the data provided need to be checked and more facts should be found.

Howden, E.J., Leano, R., Petchey, W., Coombes, J.S., Isbel, N.M., & Marwick, T.H. (2013). Effects of exercise and lifestyle intervention on cardiovascular function in CKD. Clinical Journal of the American Society of Nephrology , 8 (9), 1494-1501.

Kauric-Klein, Z. (2013). Predictors of nonadherence with blood pressure regiments in hemodialysis. Patient Preference and Adherence , 7 , 973-980.

López-Novoa, J.M., Martínez-Salgado, C., Rodríguez-Peña, A.B., & López Hernández, F.J. (2010). Common pathophysiological mechanisms of chronic kidney disease: Therapeutic perspectives. Pharmacology & Therapeutics , 128 (1), 61-81.

Smart, N.A., Williams, A.D., Levinger, I., Selig, S., Howdene, E., Coombes, J.S., & Fassett, R.G. (2013). Exercise & Sports Science Australia (ESSA) position statement on exercise and chronic kidney disease. Journal of Science and Medicine in Sport , 16 (5), 406-411.

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• Review Article
• Published: 15 September 2023

2023 update and perspectives

• Masaki Mogi 1 ,
• Atsushi Tanaka 2 ,
• Koichi Node 2 ,
• Naoko Tomitani 3 ,
• Satoshi Hoshide 3 ,
• Keisuke Narita 3 ,
• Yoichi Nozato 4 ,
• Kenichi Katsurada 3 , 5 ,
• Tatsuya Maruhashi 6 ,
• Yukihito Higashi 6 , 7 ,
• Chisa Matsumoto 8 , 9 ,
• Kanako Bokuda 10 ,
• Yuichi Yoshida 11 ,
• Hirotaka Shibata 11 ,
• Ayumi Toba 12 ,
• Takahiro Masuda 13 ,
• Daisuke Nagata 13 ,
• Michiaki Nagai 14 , 15 ,
• Keisuke Shinohara 16 ,
• Kento Kitada 17 ,
• Masanari Kuwabara 18 ,
• Takahide Kodama 18 &
• Kazuomi Kario 3  

Hypertension Research volume  47 ,  pages 6–32 ( 2024 ) Cite this article

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Total 276 manuscripts were published in Hypertension Research in 2022. Here our editorial members picked up the excellent papers, summarized the current topics from the published papers and discussed future perspectives in the sixteen fields. We hope you enjoy our special feature, 2023 update and perspectives in Hypertension Research.

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Update on Hypertension Research in 2021

Annual reports on hypertension research 2020

Epidemiology of hypertension in Japan: beyond the new 2019 Japanese guidelines

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Kokubo A, Kuwabara M, Nakajima H, Tomitani N, Yamashita S, Shiga T, et al. Automatic detection algorithm for establishing standard to identify “surge blood pressure”. Med Biol Eng Comput. 2020;58:1393–404.

Tomitani N, Hoshide S, Kario K. Novel blood pressure monitoring methods: perspectives for achieving “perfect 24-hour blood pressure management”. Hypertens Res. 2023;46:2051–3.

Tomitani N, Hoshide S, Kario K. Effective out-of-office BP monitoring to detect masked hypertension: perspectives for wearable BP monitoring. Hypertens Res. 2023;46:523–5.

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Whelton PK, Carey RM, Aronow WS, Casey DE Jr., Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71:e127–e248.

Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021–104.

Nishizawa M, Hoshide S, Okawara Y, Matsuo T, Kario K. Strict blood pressure control achieved using an ICT-based home blood pressure monitoring system in a catastrophically damaged area after a disaster. J Clin Hypertens. 2017;19:26–9.

Shibata S, Hoshide S. Current situation of telemedicine research for cardiovascular risk in Japan. Hypertens Res. 2023;46:1171–80.

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Kario K, Nomura A, Harada N, Okura A, Nakagawa K, Tanigawa T, et al. Efficacy of a digital therapeutics system in the management of essential hypertension: the HERB-DH1 pivotal trial. Eur Heart J. 2021;42:4111–22.

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Waki T, Miura K, Tanaka-Mizuno S, Ohya Y, Node K, Itoh H, et al. Prevalence of hypertensive diseases and treated hypertensive patients in Japan: A nationwide administrative claims database study. Hypertens Res. 2022;45:1123–33.

Koshimizu H, Kojima R, Kario K, Okuno Y. Prediction of blood pressure variability using deep neural networks. Int J Med Inf. 2020;136:104067.

Narita K, Hoshide S, Kario K. Short- to long-term blood pressure variability: current evidence and new evaluations. Hypertens Res. 2023;46:950–8.

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Hansen TW, Thijs L, Li Y, Boggia J, Kikuya M, Bjorklund-Bodegard K, et al. Prognostic value of reading-to-reading blood pressure variability over 24 h in 8938 subjects from 11 populations. Hypertension. 2010;55:1049–57.

Hoshide S, Yano Y, Mizuno H, Kanegae H, Kario K. Day-by-day variability of home blood pressure and incident cardiovascular disease in clinical practice: the J-HOP study (Japan Morning Surge-Home Blood Pressure). Hypertension. 2018;71:177–84.

Kikuya M, Hozawa A, Ohokubo T, Tsuji I, Michimata M, Matsubara M, et al. Prognostic significance of blood pressure and heart rate variabilities: the Ohasama study. Hypertension. 2000;36:901–6.

Mancia G, Bombelli M, Facchetti R, Madotto F, Corrao G, Trevano FQ, et al. Long-term prognostic value of blood pressure variability in the general population: results of the Pressioni Arteriose Monitorate e Loro Associazioni Study. Hypertension. 2007;49:1265–70.

Rothwell PM, Howard SC, Dolan E, O'Brien E, Dobson JE, Dahlof B, et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet. 2010;375:895–905.

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Mogi, M., Tanaka, A., Node, K. et al. 2023 update and perspectives. Hypertens Res 47 , 6–32 (2024). https://doi.org/10.1038/s41440-023-01398-5

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Issue Date : January 2024

DOI : https://doi.org/10.1038/s41440-023-01398-5

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