By Adam Bress, PharmD, MS
When I walk into the room where we store the blood samples from the Systolic Blood Pressure Intervention Trial (SPRINT) study, I don't feel like I'm just entering a lab. Inside sit nearly 40,000 small vials, each one connected to a real person who volunteered and trusted us with a part of themselves. They are people's stories, decisions, fears, and hopes.
Recently, those samples took on new meaning. Our team received a $21.6 million grant from the National Institute on Aging to investigate how blood pressure treatment affects the brain and the biology of dementia. The project feels new because of the tools we can now use-and familiar because it builds on more than a decade of work that has shaped my path in ways I never expected.
Arriving in Utah and Finding My Direction
I didn't come to the University of Utah expecting to study dementia or Alzheimer's disease. My early work focused on how people from different racial and ethnic backgrounds respond to blood pressure medications. I imagined a future centered on pharmacogenomics and drug response.
That changed after I arrived in 2014 and met Rachel Hess, MD, MS. Dr. Hess became my first mentor here and introduced me to Alfred Cheung, MD, who was helping lead the SPRINT study. That introduction set off a chain of events that would define much of my career.
When SPRINT was stopped early after clear evidence that more intensive blood pressure treatment saved lives, there was urgent work to do. We needed to understand what those findings meant for people and the U.S. adult population. I found myself leading analyses, drafting manuscripts, and learning new methods at a pace that pushed me beyond my comfort zone.
I learned that readiness wasn't the goal. What was important was being willing to stretch and surround yourself with people who help you grow into the work.
Learning to Say Yes to Hard Problems
One project from that period stands out. I took on a major cost-effectiveness analysis for SPRINT despite not being a trained health economist. Instead of stepping back, I stepped in and relied on colleagues who filled the gaps in my expertise.
I now see that decision as a turning point. Research rarely happens in isolation. It thrives when people trust each other enough to take on hard questions together. That experience taught me to embrace new methods, ask for help, and recognize uncertainty as part of growth.
How Utah Became Home to the SPRINT Biobank
The SPRINT biospecimens weren't always stored in Utah. For years, another institution maintained them. When they could no longer support the biobank, they offered to transfer it to anyone willing to take responsibility.
Maintaining a collection this large requires space, long-term commitment, and unwavering attention to detail. Leadership had to think carefully. Dr. Hess asked the right questions: "Why should we do this? What will it enable? Will it be worth the effort?"
We shared our scientific vision: how new blood-based biomarkers, especially p-tau217, could be paired with SPRINT's rich clinical data to explore unanswered questions about intensive blood pressure treatment, Alzheimer's pathology, and dementia risk.
After listening, Dr. Hess said something that has stayed with me ever since: "People in Utah may be more creative than the rest of the country. We take ideas that look too big or too messy elsewhere and we actually make them happen."
Leadership chose to take the risk, and the biobank came to Utah. With it came the foundation for the work we are now launching.
What This Grant Allows Us to Explore
High blood pressure is a modifiable risk factor for dementia, but we still don't fully understand the biological connections. Patients often ask whether treating their blood pressure will help protect their memory.
Randomized trials, including SPRINT, show that more intensive blood pressure control can reduce the risk of dementia or cognitive impairment. But the effects are modest overall, suggesting underlying biological differences. We still don't know who benefits most, through which pathways, or why lowering blood pressure appears protective for some people but not others.
Our central questions are:
- Does baseline Alzheimer's pathology-measured by plasma p-tau217-modify the benefits of intensive blood pressure control?
- How does intensive blood pressure control effect Alzheimer's and vascular disease pathways?
- How do these biological changes relate to cognitive outcomes?
By measuring modern blood-based biomarkers in SPRINT samples and linking them to long-term cognitive data, we can study who benefits, why, and how these pathways unfold over time. For patients, p-tau217 in blood offers a more accessible, less invasive way to understand what may be happening in the brain.
Our hope is simple: We want to give people clearer answers about how today's blood pressure decisions shape long-term brain health.
The Strength of a Collaborative Team
This project works because of collaboration across institutions and specialties. My multi-principal investigators-Jeremy Pruzin, MD, at Banner Alzheimer's Institute, and Jasmeer Chhatwal, MD, PhD, at Harvard Medical School and Mass General-are constant partners as the project unfolds.
For biomarker science, we work with Nicholas Ashton, PhD, and Eric Reiman, MD, world leaders in blood-based Alzheimer's markers. On the statistical side, Tom Greene, PhD, and Crystal Xu, PhD, help ensure our analyses are framed correctly and remain sound and rigorous. We're also backed by David Reboussin, PhD, and Jeff Williamson, MD, of the Data Coordinating Center at Wake Forest, along with experts in nephrology, geriatrics, and neuroradiology.
Behind all of this is our CTSI biorepository team, who ensure every sample is stored, tracked, and handled with precision. Without them, none of this science is possible.
Returning to the Freezers With New Purpose
When I return to the freezer room now, I think about the people who gave those samples. Many will never know how far their willingness to volunteer may reach. Their trust in research and our responsibility to honor it drives this work forward.
Five years from now, I hope I'll be able to answer that familiar patient question with more confidence. I hope I'll be able to say, "Yes, treating your blood pressure can help protect your brain. We know that because people like you participated in research, and because our team took on the questions that needed to be asked."
That's the heart of this grant. And it's why this work matters so much to me.
Adam Bress, PharmD, MS
Adam Bress is the Intermountain Health Faculty Scholars Presidential Endowed Chair in Population Health at the Spencer Fox Eccles School of Medicine at the University of Utah. He is the founding director of the IMPACT HSR Program at the medical school and an investigator at the VA Salt Lake City Health Care System. A formally trained cardiovascular clinical pharmacist and population health scientist, his research integrates pharmacoepidemiology, health economics, causal inference, and predictive modeling to improve the use, safety, and effectiveness of medications for preventing cardiovascular disease and dementia.
Bress has led a continuously NIH-funded research program for 11 years and is a PI on a large NIH-funded program generating the first longitudinal biomarker data on the cognitive effects of intensive blood pressure control stratified by baseline Alzheimer's disease pathology. He has authored more than 150 peer-reviewed publications, including in the New England Journal of Medicine, Circulation, JAMA, and the Journal of the American College of Cardiology. Bress received a Doctor of Pharmacy at the University of Maryland and a Master of Science in Clinical and Translational Science from the University of Illinois Chicago. He completed residencies in pharmacy practice at Yale New Haven Hospital and in cardiology at the University of Illinois Chicago.
