SCHOOL OF MEDICINE • DEPARTMENT OF MEDICINE

Jackson Wright, MD, Clinical Hypertension Program Director, discusses the importance of minority health care, explains the unique services Clinical and Translational Science Collaborative offers to investigators and shares his thoughts on the future development of the Hypertension Program.

What is the Clinical Hypertension Program at University Hospitals Case Medical Center concentrating on right now? What are some of the goals it has set for 2013?

The Clinical Hypertension Program (CHP) continues to serve patients with complicated hypertension. However, its major focus will remain its research agenda. The CHP is comprised of only two faculty, Mahboob Rahman, MD, a nationally renowned investigator in hypertension and renal epidemiology and me. However, over the past two decades, it has been successful in attracting more than $50 million of NIH and industry-sponsored research funding to the institution. CHP has held a leadership role in many of the major cardiovascular clinical outcome trials over the past 20 years, in particular those that deal with minority patients. These include some of the best known cardiovascular and renal outcome trials with acronyms like AASK, ALLHAT, CRIC, LIFE, DASH, ACCOMPLISH, A-HeFT and currently the SPRINT and SYMPLICITY trials. We plan to build on this legacy and use these high-profile studies in our portfolio to further enhance our national image. There are only a handful of hypertension programs that can boast of similar accomplishments.

Minority health care (especially in blacks) should remain a pressing topic for research because the hospitalization and mortality rates continue to be highest in these populations. In addition, the higher rates of disability result from very common disorders. Furthermore, most of the adverse outcomes occur because of the lack of data and lack of resources for better treatment in minority populations. Since this is an area that historically has been underfunded and understudied, racial health disparities continues to be a critical topic that needs to be investigated.

That is correct; we were selected to be one of five Clinical Center Networks to conduct the trial. Our network is responsible for 19 SPRINT sites in Cleveland, Columbus, New York City, Philadelphia and New Orleans. In addition to serving as a PI of Case Western Reserve University SPRINT network, I also chair both the Publications and the Intervention Committees for this trial.

The trial has just ended its recruitment phase. It had a recruitment target of 9,250 patients, and we successfully recruited 9,361. The next step is to treat the participants to either a target systolic blood pressure of less than 140mmHg or a target less than 120mmHg and follow the participants for up to four more years to see which target blood pressure is more effective in preventing the dreaded cardiovascular, kidney and neurologic (including dementia) complications of hypertension.

I am currently the Program Director of the William T. Dahms, MD Clinical Research Unit, one of three components of the CTSC; the other two units are located at Cleveland Clinic and MetroHealth Medical Center. Since 2007 we have been working with the leadership of the three units to coordinate and consolidate our resources into a single component performing clinical research involving adults and children. The access and resources of the research unit are available to all investigators at the three sites, Case Western Reserve University investigators and beyond.

We continue to provide quality inpatient and outpatient research support to clinical and translational investigators. Two years ago we opened a Phase I Clinical Research Unit, the Coleman Research Suite in University Hospitals Seidman Cancer Center. We have recently announced the opening of the community-based clinical research units at University Hospitals Ahuja Medical Center, University Hospitals Bedford Medical Center, a campus of UH Regional Hospitals, and University Hospitals Otis Moss Jr. Health Center.

Also we are now able to provide research coordinators to investigators conducting clinical research at University Hospitals. The DCRU provides expert support to investigators with inpatient and outpatient space, research nursing, metabolic kitchen, and a core laboratory for sample collection and specialized analyses. Satisfaction surveys of investigators have shown consistent positive feedback on the services that we provide.

One of the most pressing needs is to stay current both in clinical care and in research. The Clinical Hypertension Program at UH Case Medical Center is well-positioned to meet this challenge. Specifically, our collaboration with Sahil Parikh, MD, at University Hospitals Harrington Heart & Vascular Institute, is evaluating renal denervation representing leading-edge new therapy for patients with resistant hypertension. Dr. Rahman serves on the Hypertension Advisory Council for the American Society of Nephrology. I have been serving on the JNC8 Panel, that will soon publish the U.S. national guidelines for treatment of hypertensive patients. Finally, Jeff Garvinhas, MD, recently joined the Department of Physiology and Biophysics. Potential future collaborations with him and his basic hypertension research program should enhance research at this institution in both clinical and basic hypertension. With new therapies in place and improved access to both new and existing therapies, the future for the CHP at UH Case Medical Center appears quite bright.

The Department of Medicine 2011-2012 Annual Report received Silver Award recognition for print excellence and design by Printing Industries, a consortium of graphic design and printing organizations covering most of the Midwest. The department's report was submitted by Great Lakes Integrated Printing under the consortium's Annual Report judging category.

The annual report is the primary printed offering of the department summarizing yearly progress in our tripate mission of research, education and patient care. The annual report is a collaborative undertaking between the Chairman, Administrative Director, Vice Chairs, Program Directors and Division Chiefs. Report content, photography and overall production coordination is under the direction of Dasha Slobozhanina, the Department's Manager of Interactive Media and Communications.

You are invited to review the report which can be found on the Department of Medicine website.