2020 Excellence In Hypertension Award Lecturer Giuseppe Mancia
2020 Excellence In Hypertension Award Lecturer Giuseppe Mancia
Murray Esler, MBBS, PhD interviews Giuseppe Mancia, MD, PhD about his work on white coat hypertension and his career in hypertension research.
Content
1.95 -> [Music]
7.759 -> i'll be speaking today with professor
10.24 -> giuseppe mancha uh professor mancher
14.08 -> from
14.92 -> milan is this year's winner of
18.08 -> the council high blood pressure
21.119 -> excellence
22.24 -> research award very very distinguished
26.96 -> award always very
30 -> keenly contested and giuseppe is an
33.12 -> extremely
34.079 -> worthy winner and the title of his
37.76 -> award lecture at this meeting will be
42.399 -> on white code hypertension so i would
45.76 -> like to say hello giuseppe and
50.8 -> and perhaps you could tell us uh about
54.399 -> some of your work on white code
57.039 -> hypertension
58.719 -> we started doing research on white coat
62 -> hypertension which
63.199 -> is the theme of my presentation
67.439 -> and the systematic research started with
70.56 -> the population study
72.479 -> were devised and conducted in the
76.08 -> northeast start script of milan a
78.08 -> population study the pamela studied
81.119 -> which initially was aimed at providing
84.96 -> normality values for ambulatory blood
87.439 -> pressure
88.479 -> but the study had a number of unique
90.799 -> features
91.6 -> each individual of the population had
93.759 -> the measurements of
95.439 -> office home and ambulatory blood
97.439 -> pressure each individual had an
99.4 -> echocardiogram
100.64 -> and that was a very long follow-up and
103.36 -> so
104 -> it was suited to look at this condition
107.36 -> which began to be of interest
111.2 -> in the medical community why code
113.28 -> hypertension
114.72 -> and we were able to collect the number
116.64 -> of novel data
118 -> prevalence which is very high and then
121.28 -> the fact that
122.64 -> contrary to what was believed it is not
126 -> a clinically innocent condition because
128.479 -> it has people having this have
132.56 -> quite frequently open damage they have
135.599 -> metabolic risk factors they have a
137.76 -> greater risk of moving to
140.64 -> establish hypertension and even the
142.879 -> nuances of diabetes
144.879 -> and they have a risk of having
146.319 -> cardiovascular events in the long
148.64 -> run which is less than those having true
151.68 -> hypertension
153.12 -> but definitely greater than the truly
155.76 -> normative
156.72 -> subjects we're continuing
160.16 -> unfortunately being an observational
162.239 -> study
163.2 -> pamela is not suited to answer a final
166.72 -> very important question which is shall
168.8 -> we
169.36 -> to this condition or not we were able to
172.959 -> get
173.519 -> blood pressure data from another trial
176.319 -> another study which was the elsa study
179.12 -> but this remains a very important
181.12 -> outstanding
182.239 -> question the findings are really
185.239 -> revolutionary i know
186.959 -> the white coat hypertension often has
189.92 -> just been thought of as a nuisance
192.56 -> but clearly there's a lot more to it
195.36 -> than that
196.64 -> if i could just uh shift pace for a
199.599 -> moment
200.4 -> i know that in your early days
204.239 -> you worked in usa on experimental
207.84 -> medicine
209.28 -> what what influence did that have on you
212.799 -> for 15 years
216 -> my working life i only did
219.519 -> or almost only did experimental research
222.64 -> in animals
224.72 -> first in milan and uh a very
229.12 -> uh important mentor professor at veto
232 -> zhang kita in which we studied
234.4 -> the hemodynamic changes during sleep and
237.28 -> during emotional behavior
238.959 -> and then at the mayo clinic in the
241.2 -> united states
242.959 -> when i studied the
246.12 -> cardiovascular reflex control by
249.2 -> receptors in the heart and lungs these
252 -> were
252.56 -> really very important days for me
255.28 -> because
257.759 -> i just learned doing research and
260.88 -> particularly in united states
263.919 -> i was very lucky because i met with
268.96 -> incredibly good mentors professor
271.44 -> shepard
272.479 -> and professor donnell they were not only
275.919 -> extremely good at research but very
278.32 -> generous
279.04 -> i mean i learned a lot from
282.479 -> them and this is of course extremely
284.639 -> important in the early working life
286.96 -> of an investigator and in addition of
289.759 -> course the studies on
291.8 -> cardiopulmonary receptor control of the
294.08 -> circulation were new and they
296.56 -> showed for the first time that there is
298.4 -> indeed a powerful control of the
300.32 -> circulation in particular
302.08 -> renal circulation and renal release from
304.96 -> these volume receptors which provide a
307.36 -> sort of homeostatic control
311.28 -> of blood volume and when i came back in
314.4 -> milan
314.96 -> was capable i was able to
318.16 -> replicate some of these data in humans
322.32 -> and it was just about the same very
324.88 -> powerful control of blood volume
327.52 -> in pneumothor hypertensive humans and
330.08 -> this
330.56 -> tends from the heart mainly
333.6 -> and this we were able to demonstrate by
336.88 -> looking at the absence of these reflexes
339.36 -> in
340.24 -> people with the heart transplantation
343.919 -> thank you very much very important work
347.24 -> cardiopulmonary santa's
350.8 -> centers and reflexes help us all stand
353.6 -> up
354 -> of course um
357.44 -> just to extend things a little um
361.199 -> you've made so many contributions
365.12 -> is the one that you're proudest of
368.72 -> it's perhaps the
371.84 -> latest ones are those you like most
376.08 -> in the last 15 years for example i moved
378.72 -> to an
379.12 -> area which was alien to me
382.96 -> and this is a real life researcher
385.199 -> taking advantage first of all
387.28 -> of a great collaborator a very good
391.12 -> statistician professor corral
393.36 -> and the fact that he had access to a
395.759 -> very important database along with the
398.319 -> all citizens from lombardy about 11
401.199 -> million people in which
403.199 -> there is a detail you can have detailed
406.84 -> information
408.08 -> on treatments they're taking
409.88 -> hospitalization causes of
411.639 -> hospitalization of course
414.08 -> a number of deaths and so forth and this
417.44 -> has led us to
418.96 -> a number of studies on adherence to
421.36 -> treatment
422.16 -> therapeutic inertia and these are area
424.96 -> of very great interest today because we
427.52 -> realize that we can have the best drugs
430.08 -> in the world as far as hypertension
432.16 -> diabetes
433.12 -> or these lipids are concerned but
436.319 -> if people do not take them
440.08 -> or if physicians do not step up
443.12 -> treatment
443.759 -> until there is a control of these risk
446.319 -> factors of course
448.08 -> results are quite poor and using this
451.52 -> database
452.319 -> we were able only a few months ago
456 -> based also on a very interesting paper
459.28 -> published by you murray in
462.4 -> the journal hypertension on the possible
465.44 -> relationship between
467.039 -> very common drugs life-saving drugs such
469.759 -> as
470.56 -> blockers of the lineage retention system
473.68 -> and the kovid infection to look at
477.039 -> whether people with the cavite 19
479.44 -> infection
480.24 -> were taking these drugs
483.919 -> before the infection and these drugs
486.479 -> could modify
487.44 -> the risk of the severity of the disease
490.24 -> and we had a lot of people to look at of
492.879 -> course
493.44 -> and the final uh conclusion from this
496.56 -> study was that
497.759 -> no these drugs are used more frequently
502.16 -> but
502.56 -> this is a reflection of the fact that
505.12 -> sicker people
506.479 -> and these drugs means that you are
509.599 -> sicker because you have hypertension or
511.68 -> heart failure or some other diseases
513.44 -> sicker people get infection
515.68 -> more easily but there is no reason to
518.08 -> conclude
518.959 -> that these drugs have
522.64 -> a specific effect on the risk of the
526.08 -> infection
526.8 -> or the severity and lethality of the
530.08 -> infection
531.6 -> i know that research too well you proved
534 -> me wrong
535.6 -> i thought the drugs might be a problem
539.2 -> you found the truth well this was the
541.76 -> hypothesis which of course
543.6 -> was you know very important because
546.56 -> people were scared and they started
548.32 -> stopping treatment and we know that
550 -> stopping
550.959 -> life-saving treatment is accompanied by
553.44 -> an adverse rebound for the risk of
555.68 -> cardiovascular events
557.839 -> i have one final important question
561.279 -> for you and
566.72 -> what advice might you give to
570.08 -> a young clinician's clinician scientist
573.92 -> starting their research career what much
576.24 -> you tell them
577.36 -> well i of course unbiased my my
580.08 -> experience
582 -> my experience has been that you do need
585.04 -> great mentors first of all this is the
587.92 -> crucial thing
589.44 -> great mentors and generous mentors those
592.64 -> that
593.04 -> can really they can they really love
596.88 -> to teach people and having people
600 -> growing
601.04 -> in research and i was lucky because both
603.6 -> in milan
604.959 -> in my early years and then in united
608.24 -> states
609.2 -> i did have great mentors
613.04 -> of course you also had to be lucky the
615.36 -> areas of research you pick up
619.76 -> must be in a way productive areas and
623.279 -> you never know in research
625.44 -> you may come to a blind alley sometimes
628.56 -> but this happened to me but not so often
631.839 -> fortunately
633.76 -> thank you very much now i should say to
636.88 -> everybody
638.24 -> make sure you catch versa manches
642.16 -> lecture i've been privileged to see all
645.6 -> his powerpoint slides
648 -> and it will be a real knockout talk
651.68 -> thank you thank you thank you murray
653.839 -> thank you
664.32 -> you
Source: https://www.youtube.com/watch?v=79cC0liVPHw