Academia and industry working together to close gaps in hypertension care

AstraZeneca and Duke Clinical Research Institute in the US are collaborating to better understand hypertension care in everyday practice and generate evidence that could help improve it.

How can research help address the gap between established treatments and blood pressure control in everyday care? That question sits at the heart of AstraZeneca’s collaboration with the Duke Clinical Research Institute (DCRI), the largest academic clinical research organization in the world.1

Through REFOCUS-HTN, a real-world US-based research initiative, AstraZeneca and the DCRI are combining their expertise to investigate gaps in hypertension care and generate evidence that could help inform future approaches to disease management.

The REFOCUS-HTN infrastructure is designed to support embedded studies, pragmatic trials and research into how evidence can be applied in clinical practice. This creates opportunities to investigate approaches to care using the same research foundation, rather than stopping at the identification of gaps.

Understanding everyday care

Hypertension affects 1.4 billion people aged 30 to 79 worldwide and is the most prevalent and significant modifiable cardiovascular risk factor globally,2 accounting for more deaths and disability than any other modifiable risk factor.3,4 Despite the availability of effective treatments and established clinical guidelines,5,6 millions of people living with hypertension do not achieve recommended blood pressure targets,7 increasing their risk of cardiovascular and kidney disease.8-10

While effective treatments for hypertension are available, too many patients continue to live with uncontrolled blood pressure and its serious consequences. Working with the DCRI – a 30-year pioneer in cardiovascular clinical research - our shared ambition is to generate evidence that is more relevant to everyday patients and use those insights to help improve hypertension care for patients.

Martin Cowie VP, Global Medical, CVRM, AstraZeneca.

Through REFOCUS-HTN, the collaboration is building a research foundation designed to bring together electronic health record data from 20 US health systems through PCORnet, the national patient-centred clinical research network. The research will examine blood pressure control, patterns of care and longer-term clinical outcomes. By studying the care of millions of people with hypertension over time, researchers aim to identify where care falls short and where opportunities for improvement exist, creating a foundation for further studies.

What we're learning so far

The initial findings from U.S. health systems in REFOCUS-HTN were presented at the American Heart Association Scientific Sessions in November 2026, highlighting persistent gaps in hypertension care. The data aimed to characterise blood pressure control, clinical profiles, and treatment patterns among adults treated for hypertension in 2025 from US health systems in REFOCUS-HTN.11

Among 161,317 patients with hypertension and treated with ≥1 antihypertensive medication, 60.6% had uncontrolled blood pressure ≥130/80 mmHg. Rates of uncontrolled blood pressure were similarly high among patients prescribed one, two, or three or more antihypertensive medications.

Most patients had their blood pressure measured several times in the preceding year, yet many remained uncontrolled, highlighting a need to better understand barriers to achieving blood pressure control.11

Regardless of demographic, health insurance, or comorbidity subgroup, the proportion of patients with uncontrolled blood pressure ranged from 49% to 69%. Lower proportions among patients with comorbid cardiovascular/kidney/metabolic conditions were consistent with prior studies and likely reflect more intensive care after comorbidity onset.11

Despite the availability of multiple agents, despite guidelines having strong recommendations for years, we have made limited progress in getting people's blood pressure under control. These initial findings from REFOCUS-HTN underscore the persistent gaps in blood pressure control, and potential opportunities in clinical practice to help more patients achieve blood pressure control. There remains an enormous unmet need for improved care delivery and for implementation of effective therapies in clinical practice. A partnership between academia and industry is a great way to try to accomplish these goals.

Stephen Greene MD Principal Investigator of REFOCUS-HTN and cardiologist at DCRI

Looking ahead, AstraZeneca and the DCRI aim to build on these initial findings through further research to better understand barriers to effective hypertension management and identify opportunities to improve care. Over time, the collaboration could also provide a foundation for research across other cardiovascular, renal and metabolic diseases.

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References

  1. Duke Clinical Research Institute. Trusted. Innovative. Effective. [Available from: https://dcri.org]. Access date: November 2026.
  2. WHO. Hypertension: World Health Organization; 2025 [Available from: https://www.who.int/news-room/fact-sheets/detail/hypertension]. Access date: November 2026.
  3. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1223-49.
  4. World Health Organization. Global report on hypertension: The race against a silent killer. 2023. [Available from: https://www.who.int/teams/noncommunicable-diseases/hypertension-report]. Access date: November 2026
  5. Jones DW, Ferdinand KC, Taler SJ, Johnson HM, Shimbo D, Abdalla M, et al. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM 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 Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2025;86(18):1567-678.
  6. McEvoy JW, McCarthy CP, Bruno RM, Brouwers S, Canavan MD, Ceconi C, et al. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. Eur Heart J. 2024;45(38):3912-4018
  7. Carey RM, Sakhuja S, Calhoun DA, Whelton PK, Muntner P. Prevalence of Apparent Treatment-Resistant Hypertension in the United States. Hypertension. 2019;73(2):424-31.
  8. Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016;387(10022):957-67.
  9. Zhou D, Xi B, Zhao M, Wang L, Veeranki SP. Uncontrolled hypertension increases risk of all-cause and cardiovascular disease mortality in US adults: the NHANES III Linked Mortality Study. Sci Rep. 2018;8(1):9418.
  10. American Heart Association. High blood pressure and your kidneys. [Available from: https://www.heart.org/en/health-topics/high-blood-pressure/health-threats-from-high-blood-pressure/high-blood-pressure-and-your-kidneys]. Access date: November 2026.
  11. Greene S, Xu H, Mentz RJ, Nekeman-Nan C, Coto E, Mares J, et al. Healthcare gaps in uncontrolled hypertension in two US health systems: A REFOCUS-HTN analysis. Abstract submitted to: Annual Meeting of the American Heart Association; Chicago, Illinois, US; November 6-9, 2026. Abstract #2026-A-4890-AHA.

Veeva ID: Z4-90428
Date of preparation: November 2026