High pressure talk with Professor Rhian Touyz

Our scientists and clinical researchers have discovered a treatment called thrombolysis, otherwise known as thrombolytic therapy, which is a treatment to dissolve dangerous clots in blood vessels, improve blood flow, and prevent damage to tissues and organs. They discovered that the sooner you complete thrombolytic treatment, the greater the chance of survival for stroke patients.

One of our stroke specialist doctors has also played a very important role in the establishment of a stroke unit, in terms of when the patient comes in, what should be done and how the stroke unit should be organised effectively – this makes a greater difference to the outcomes for stroke patients.

I believe we’re going to see big advances in using new technologies and methods to understand the fundamental processes of cardiovascular disease

As well as being the director, you are a clinician scientist carrying out research into hypertension, with an active role in patient care. How do you find the time to balance each of these positions?
To be honest, it is demanding and challenging. Although, I am very fortunate because I have a great network of wonderful supportive staff along with an outstanding PA who helps run everything. Hence it boils down to great team work. I am truly blessed because I thoroughly enjoy every aspect of my work – from the leadership to the discovery science as well as mentoring students to treating patients.

In terms of balancing my leadership, clinical, and research role, it all comes down to effective time management and prioritising the work that really needs to get done. These skills allow me to carry out these roles successfully.

That sounds like a good recipe. What initially triggered your interest in hypertension research?
My interest in hypertension research goes back many years ago to when I was a medical student on a hospital ward and I witnessed a very young man have a terrible stroke. He essentially became a quadriplegic, (a person affected by paralysis of all four limbs). I asked the consultant at the time, why did this young man have a stroke and change from being healthy to totally incapacitated? The consultant said, “This patient had severely high blood pressure and had that blood pressure been controlled, the stroke could have most likely been prevented”. At that time, I asked, “What are the causes of high blood pressure?” with the reply that, “We don’t know exactly what the causes of high blood pressure are”. Therefore, my interest all stems from this first-hand experience. I became intrigued to try to discover the causes of hypertension, and since then, I have specialised in that field.

I’m very interested in trying to understand what causes high blood pressure, as we already know that if you prevent hypertension or properly control blood pressure, other conditions directly linked to cardiovascular disease can be prevented. By preventing patients from getting strokes, heart failure, heart attacks, atrial fibrillation, dementia, or becoming dependent upon on dialysis, where they can’t work anymore and where they spend a lot of time in hospital, we would have a much healthier population; from a public and economic health point of view, this is much more attractive. That’s why I’m so committed to this research and study to try to prevent it or at least better manage it.

So you’re now based in Scotland, but were originally from South Africa, and have worked across North America – do you find that attitudes to cardiovascular disease differ in each region?
Cardiovascular disease is a really important cause of both morbidity and death across the whole world. We used to believe that it was only in the more developed western world that this was a problem. However, today we now know that globally, cardiovascular disease is the major cause of morbidity and death. We believe this is down to the fact that cardiovascular disease, especially hypertension, causes strokes, heart failure, kidney disease, and even vascular dementia.

Modern medicine of the near future will focus on treatment of the specific disease characteristics of each individual patient using a personalised or precision medicine approach

In terms of the attitudes of the professionals, I think today everybody appreciates that cardiovascular disease is a medical priority that needs attention. In each region I’ve worked in, I found that the focus on prevention is very important, especially in terms of lifestyle modifications. Although, in Canada, South Africa and here in Scotland, some of the treatment protocols are a little bit different.

Of course, while all patients are appreciative of good medical care, there are a few notable difference in patient attitudes across the different regions. In North America for example, patients tend to assume more responsibility for their own health and medical situations. Whereas here in Scotland, patients give most of the decision-making responsibility to the doctors. Of course, this is just from my personal observations and experiences. At the end of the day, it’s really important that patients get the best medical care that is appropriate for their particular disease.

How do you think cardiovascular research will develop during the next decade?
I think we’re at the start of a very exciting time for cardiovascular research; in fact, for all biomedical research. I believe we’re going to see big advances in using new technologies and methods to understand the fundamental processes of cardiovascular disease. For example, we talk about precision medicine today, understanding the exact genetic make-ups in each individual patient, in terms of protein, metabolism and fats that can contribute to the formation of diseases. I think this is all going to become much clearer in the years ahead, and hopefully modern medicine of the near future will focus on treatment of the specific disease characteristics of each individual patient using a personalised or precision medicine approach.

I also believe that we might see the emergence of different methods in the way we treat patients. Maybe we’ll use different strategies, rather than using drugs as we know them today. We may use things like nanotechnology, enabling more sophisticated diagnostic opportunities and yielding improved treatment. Essentially, new technologies and new approaches will advance over the next few years, along with the development of a greater understanding about the very fundamentals of disease processes. Finally, we may even see more management and treatment done within the home, where patients and doctors will be ‘hooked up’ through mobile apps and other technologies.

• For more information about the Institute of Cardiovascular and Medical Sciences at the University of Glasgow, please visit their website at www.gla.ac.uk/researchinstitutes/icams/.