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George Bakris – Irvine Page Alva Bradley Lifetime Achievement Award Winner

– George, congratulations.
– Thank you. – You are this year’s recipient of the Irvine Page and Alva Bradley
Lifetime Achievement Award. I was wondering George,
for those listening today, if you could give us some examples of the highlights of your career that have led to this wonderful award. – Well thank you very much, Karen. I have to say that’s in
an auspicious occasion to have this in New Orleans, which is where I started my career. And actually a lot of the work that I have to give credit to started in this town, with the help of people
both at Ochsner Clinic and Gabby Navar’s group at Tulane. So we really started off in cell culture looking at endothelin and showing that endothelin is produced by
mesangial cells in the kidney and then in fact it’s a transmitter. And under diabetic
conditions, actually plays a major role in the
pathology of the kidney. So then from there we
actually did clinical studies at LSU where we were looking at, again, diabetes models in the
kidney and focusing on changes in albumin excretion
rate and blood pressure, and looking at different
therapies and combining them. And that led to the
combination of ACE inhibitors and Diltiazem as being preferred over other calcium antagonists
for lowering proteinuria and actually preserving kidney
function to a certain extent. And then after that,
funding became very tight. I moved around and I left
the cell culture world and moved more into clinical research. And fundamentally got
involved with clinical trials, and some major NIH and industry trials in diabetes and the African American study of kidney disease from the NIH, RENAAL. We’re currently now just finished CREDENCE which is a diabetes study in the kidney. And I have a very large
diabetes outcomes trial, FIDELIO, which is going
to report within the year looking at kidney outcomes. And again, these are in
people with hypertension and diabetes and kidney disease. And that’s pretty much
what I’ve been doing so really have kind of come full circle. We’re done the cellular stuff. We’ve done studies looking
at inter-renal hemodynamics and now we’re really, since 1993, my career has really been focused on clinical outcome trials and some smaller pathophysiological studies in man. – Well George your career has certainly covered the entire
spectrum from cell culture to now human studies. And you certainly have your finger on the pulse of the field of hypertension. I’m wondering what do
you see as the future of hypertension treatment in the patients that suffer from this disorder? – So that’s a very good question. We have about a 125 different
anti-hypertensive medications right now and these
medications are actually, if you know how to use
them and what doses to give and when to use them, are
actually pretty effective, assuming patients take the drugs. And I think the way I see the future is, not so scientifically sexy
as much as it needs to be more focused on education of the patients and really applying what we know. Because we know a lot, and a
lot of it isn’t being applied. What am I talking about? For example, we know very well,
it’s in all the guidelines, it’s been in the guidelines
since I can remember, low sodium diet, exercise, weight loss, good sleep, will help
reduce blood pressure. And in fact we now know
that if you don’t adhere to a low sodium diet, there’s no point in using ACE inhibitors and
angiotensive receptor blockers, because they won’t work, because
the system is suppressed. So that sounds very naive and simple, and especially if you’re a
researcher you’re going to say, come on, doesn’t everybody know that? Trust me, they don’t. So I think we need to educate patients on the importance of a low salt diet. I think we need to try and help them, with the help of dieticians and I know those are not readily available, but if we can have access to them we need to make sure the patient understands how to apply a low sodium diet. And we’re doing this
actually in my center, and it takes time, time
we’re not getting paid for, but once the patients see
that you’re taking the time and they try it and it works, and it will, then what happens is they
have more confidence in you. If they have more confidence in you, they’re more likely to
take the medications that you’re giving them,
especially if you are responsive to any problems that they may have, and warn them in advance. So I think really the future, clinically, is to take what we know
and start applying it. And if we do that, we’re going to have far better blood pressure
control than we have right now. So that’s number one. Number two, I think we
have mechanistically the last anti-hypertensive
that was approved was in 2006. So there’s not a lot of
drug development going on in new anti-hypertensive medications. Having said that, again I think we have seven to eight different
mechanisms that can be utilized in combination. And combination therapy has
been advocated since 1996. There was a clinical trial
called the ACCOMPLISH trial that was published in 2008
in New England Journal, which was an outcome trial showing on combination was better than another. And yet clinically, physicians
are still recalcitrant in using combination therapies. So we really need to
streamline the pill count and use medicines that have
been proven to be of benefit, not theoretically, not
just lowing blood pressure, but actually impact outcomes. So I think that needs to happen. And I think in terms of
research, basic research, there’s a lot of interactions
that are just now starting to be discovered. So what am I talking about? The gut microbiome is an
untapped bastion of research that we really are just
starting to learn about and its contribution to hypertension, overall inflammation, and other issues. And I think that’s a major
area that we need to move into. Additionally to that, there
is a whole separate area of sleep and sleep disorders
that affect hypertension and blood pressure variability. And I’m not talking about sleep
apnea, that ship has sailed. Fundamentally if you treat sleep apnea you get one millimeter per
one hour of the blower. That’s not really helping
you, let’s be honest. But sustained sleep, sleep quality, lack of good quality
sleep, uninterrupted sleep, less than six hours is,
especially in older people, associated with increased blood pressure, increased blood pressure variability, and so called masked
hypertension where people wake up with pressures that are okay and they’re at home, they’re
watching TV who knows, and all of a sudden their pressures spike. And nobody understands that. We have data to suggest
that if you reinforce and reinvigorate good sleep patterns, and get people sleeping
again, so they’re sleeping at least six to seven hours, that in fact you can restore better
blood pressure control and reduce the variability. In fact, we’re just getting
ready to publish this. So very important area of research that needs detailed research. Because all I’m giving you
in kind of the clinical perspective but the basic
science perspective, from a CNS-neurology
standpoint, is untapped. And then there’s a whole
other thing central pressures, the meaning of central pressures. Are they actually a better predictor? There’s a whole controversy about that. And so the mechanisms of modulating blood pressure in older people. So endothelilal cells are
not what they used to be when you’re 70, nitric oxide
release isn’t the same. There’s a lot of different things. And I’m just scratching the surface now. So there’s a lot of integrative research that remains to be done. – Well clearly it’s easy to see why you’d be an excellent
mentor and I’m wondering what advice you’d have for somebody who’s just starting their careers now in the field of hypertension research. – So this is an excellent
question, it’s a tough question. As you know, I mean I’m going
to be very honest about this, funding in hypertension is tough, if you’re just going at pure hypertension. So you need to link hypertension,
either mechanistically from an understanding standpoint,
or if you’re going to do epidemiology or even clinical trials, you’ve got to link it with
some other disease process that is going to be affected by you affecting blood pressure. So clearly again, if you want
to link the gut microbiome to hypertension to outcomes, that’s fine. If you want to look at
people with diabetes, obesity, there’s a lot of work being done in obesity right now. And again depending on where
you want to go with this, not all the questions have
been answered by any means, and so you need to find an area you like, you need to read up on
everything that is known in this specific area that you want to do. Not everything, but if you
want to do basic science, okay pick an area of basic science that you’re interested in, read that, and then from within, what
are the unanswered questions? Start there, and hopefully
you’re with a mentor that can guide you through
that so that you can start creating a portfolio for yourself and build on it with subsequent questions that are being answered, and just like you and I did in our careers. And that’s really what you need, but you have to have an
internal zeal for this. This has got to be, not a job,
this has got to be a passion. And it’s got to be something that you need to wake up everyday and be excited about. The moment that stops,
you’re going to have a major problem because then it is work, and this really is work,
it’s not just a little work, it’s a lot of work,
and you’re going to get frustrated soon and burn out. So you don’t want that. So that’s why it’s critically
important in the beginning to pick an area that’s really
near and dear to your heart. – Well thank you George,
that’s excellent advice and I’m sure they’ll be a lot of trainees listening to this and I
hope they heed that advice. – Thank you. – Again, congratulations on
this very well deserved award, the lifetime achievement award. – Thank you very much, Karen.

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