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Arterial hypertension is the leading risk factor for premature death and disability-adjusted life years in the world. Lifestyle interventions and drug treatments achieve blood pressure normalization in only half of the affected patients. In around 20% of the remaining cases, blood pressure is insufficiently controlled despite the concurrent administration of different antihypertensive agents. This condition of resistant hypertension is associated with greater risk for developing adverse cardiovascular events and with unfavorable prognosis. The HYRENE program intends to identify key factors underlying the development of resistance to therapy that may become modifiable targets for improved treatment of affected individuals.
The success of the program relays on the convergence of clinical, pre-clinical, and applied science research into a common consortium.
On a global scale, high blood pressure is the leading risk factor for premature death and disability-adjusted life years (DALYs). In Switzerland, about one third of adults are diagnosed with hypertension. The clinical and economic impact of this condition is substantial as over 18% of deaths and nearly 8% of DALYs are linked to hypertension. In the aging and more obese population, the incidence of this relevant clinical scenario is expected to further increase.
Aims of the research project
The overarching aim of the HYRENE program is to identify key factors underlying the interrelation of high blood pressure with the condition of resistant hypertension that may become modifiable targets for improved treatment of affected individuals. To achieve this goal, we intend to improve diagnostic tools that provide the possibility to delineate pathophysiological mechanisms most probably underlying the development of the resistance to therapy. The success of the program relays on the convergence of clinical, pre-clinical, and applied science research into a common consortium promoting the translation of the scientific and technological advances of the pre-clinical research into patient care, and back.
Specifically, we aim:
- to build an interdisciplinary research network for hypertension composed of clinical and basic scientists of the University Hospital of Zurich and of the University of Zurich;
- to promote the investigation of mechanisms underlying resistant hypertension in pre-clinical models and in patients
- to develop cutting-edge diagnostic solutions for treatment of hypertension (e.g. 23Na-MRI, urinary exosome analyses, platform for autoantibodies screening and multi-steroid analysis);
- to support and promote interdisciplinary educational research;
- to encourage and sustain talented young clinical scientists.
Relevance and added value
The HYRENE program offers the opportunity of addressing the multifaceted and clinical relevant problem of resistant hypertension using a multi- disciplinary and translational approach. With the present program, we aim to coordinate our research projects into a common conceptual framework by creating a local environment that allows different projects from participating departments to interact with and to benefit from each other.
Perspectives for the following years
Personalized medical treatment of hypertension requires the development of diagnostic and therapeutic strategies able to identify and potentially reverse pathological mechanisms in individuals.
In this context, the HYRENE program is the first phase of a longer-term research strategy aiming to: the phenotyping (i.e. the identification of specific characteristics for each hypertensive person included in the program), the stratification (i.e. the identification of common characteristics within the hypertensive population), and the personalized treatment of individuals. The first period of the program will be entirely devoted to the deep phenotyping of the participating patients. The successive 3 years of the overall program will address the second phase of the general strategy concerning the stratification of the hypertensive population and the individuation of best-responding therapeutic strategies for the single phenotypes. The utmost goal of this second period of the HYRENE consortium will be the phenotyping of individuals not responding to current treatment strategies and the initial development of novel treatment approaches targeting the pathological mechanisms in those individuals. This, in turn, will constitute the basis for the long-term third phase of the general strategy (personalized treatment).