Hypertension, Obesity, and COVID-19
Hello and welcome to conversations. With dr bachner it is howard bachner editor-in-chief. Of jama. And this is one of my most. Uh unique conversations. I am joined. Uh by two leaders. At the national, institutes. Of health. Gary gibbons, is the director, of the heart lung, and blood institute, he has been since, 2012.. He's a board certified, cardiologist. And. His budget is about three billion dollars he has about a thousand employees, in nhlbi. Gary welcome. Thank you howard pleasure to be here, and, uh griff rogers. Um. Who is the director, of the national, institute, of diabetes. And digestive, and kidney, disease board certified, in hematology. He's been director, since uh 2007.. He's, also a member of the jama editorial, board. Um, his budget, is up, about 2.1. Billion dollars and he has about, 700. Employees. And they've. Written. A remarkably. Powerful. Editorial, to accompany, two papers that, we published, uh yesterday, one yesterday one last week. The title, of the editorial. Is obesity, and hypertension. In the time of covet 19. By uh griffin rogers, and gary gibbons. The two articles, that they're commenting, on and that we'll discuss. Today. Uh the first, is by paul muttner, and colleagues, entitled, trends in blood pressure. Trends in blood pressure control among u.s adults with hypertension. 1999. 2000, to. 2017-2018. And then trends in obesity, prevalence by race and hispanic, origin. Uh 1999. 2000, to 2017. 2018.. And, and gary i thought i'd start. By just summarizing, the data, that that you allude to, in the editorial, and just to. To talk about it i i found it so. So disturbing. Muttner, estimates, the proportion, of adults. With hypertension. Who had controlled, blood pressure, increased. From 31.8. Percent 1999. To 48. In 2017.. Remain, stable. Between, 20, uh remain stable to 2013. 2014. But then declined. Declined. From, 48.5. Percent, to, 43.7. Percent. Uh over, uh, that four year period. Gary. Were you as disturbed, when you saw these data, as i. Was. No howard i think you're you're exactly, right, uh this is a very concerning, trend. Um. We know, uh one of the success, stories i believe, in biomedicine. Is the reduction, of cardiovascular. Death over the last, 50 years or so. In part related, to effective. Control, of risk factors. And we know, and have abundant, evidence, that lowering blood pressure works prevents strokes heart attacks, heart failure etc, we've known that for a few decades, now. Uh and we've done particularly the nhlbi. Uh. Had a leading role in, enhancing, awareness. Uh in the public, about the silent killers it used to be called back in the 70s and 80s. Uh and so uh with, there have been guidelines. For again decades, as part of the jnc, tradition. Uh to try to really galvanize, the public and practitioners. Uh that controlling, blood pressure is important, and yet.
Uh As you're pointing out, we have less than, half our population. Uh that's controlled. Uh and so, there are lives that will be lost as a result of that, uh and it's, particularly, uh concerning. In light of the fact that uh, the nhlbi. Sponsored the sprint, trial. Which i think is one of the milestone. Trials, of of the 21st, century. In showing that, even, more aggressive, lowering blood pressure. Prevents, strokes, heart attacks, heart failure, and saves lives. So when the data's getting stronger and stronger. About, how important blood pressure lowering is, it is frustrating. That, the control rates, seem to be lagging. Gary the other thing and then griff we'll get we'll get to the obesity, data. The black white differences. Are more pronounced than ever before. And they're very pronounced. Around, who has access, to regular, care and who doesn't have access, to regular, care. I i do also want to make sure people recognize. That the definitions. Used to represent, control, was identical, during the reporting, period. Even though there were some new definitions. Introduced, there's a, sensitivity. Analysis, based upon the new, definitions, but these comparisons. Are apples to apples, over the years. Gary can you just comment on the black white difference, and access to care obviously, they often go together, but but i'm wondering if you could, say a few words about that. You know that that is a, another, element, of the disturbing. Trend, it uh who seems to be most adversely, affected. Uh and indeed uh that, that has a a social dimension, to it uh, uh in which uh, you, think it it lays bears in the social determinants, of health, uh that is beating into, uh racial. And other health disparities. Uh and so really since it's a matter of. Doing what we know works. We already have evidence. It's really. Back to how do we deliver. Quality, care, to all americans. And and this is really. A canary in a coal mine it's telling us we have a problem here. In making sure that all communities. Are getting, evidence-based. Care. Now griff the data. Around obesity, i don't think will surprise, people, um. When we talk about an, epidemic. Or pandemic, obesity, has become a worldwide, problem, it is a pandemic, so i'll. I'll read the data that you summarize, in the editorial. Uh again 1999. 2017. Um. Increased. The prevalence, of obesity, increased from, 27.5. To 43. For men and 33. To 41. For women. And their prevalence, of severe. Obesity. Bmi, greater than 40, increased from 3.1. Percent. To 6.9. For men and 6.2. Percent, to 9.7. For women. And again. A number of subgroup, analysis, the prevalence, of both, uh are greater, that is, obesity, and severe obesity, for non-hispanic. Black women fifty six point nine percent and eighteen point nine percent, respectfully. And mexican, american, women forty nine point six percent and fourteen, point five percent, than white women thirty nine point eight percent eleven point three. Percent. We've been at it for a decade. Griff. I mean we've talked to that we've talked about it at our editorial. Board. Is it intractable. Is it is it can we not solve this problem. Well it is a problem and in fact one of the one of the, let me just highlight one additional, subset, analysis, that was. Reported, in the ogden, paper. They looked at at, individuals. Between, six to eleven, years.
In In adolescence. In which the prevalence, has also, increased. From 15.8. Percent to 19.3. And 16. To, about 21. Respectively. In those two groups, and this is particularly. Concerning. Because we know that severe, obesity. Is a major risk factor for type 2 diabetes. In youth. Which is a more severe, course. And responds. Less well. Than treatments. For, diabetes. Later in life. But the second point in an adults. Again we're just seeing this this general, increase. In, this epidemic, of obesity, as as you pointed out i mean we're we're in the midst of a pandemic. Now, and and obesity. You know if you were to kind of put this in a communicable. Disease. It would obviously. Be right up there front and center. Because obesity. Uh is such a risk factor for so many other conditions, involves. Cardiovascular. Disease. Non-health. Uh non-alcoholic. Fatty liver disease, which, by the way is now. Becoming, the. The the more likely, cause of cirrhosis. Uh i was just off of us just got off of a zoom meeting. In which we were reviewing, data on obesity. As risk factors. Uh, for, certain types of cancer. That have been published, recently, in, jama. Unlike, hypertension. In which there's really, a. Very large number, of therapies. Available. Which is, as, as gary indicates, very disconcerting. The therapy. Either. Pharmacist. Pharmaceutical. Therapy. Uh, uh or. Behavioral. Modifications. Telling people to eat better and exercise. More, just has not been. As effective. As we'd like. And again this is a a, condition, because of the, the social, context. And the other related, aspects. About, eating. And, exercise. And sleep by the way which is sort of the third. Stool, uh leg of that stool. Uh, we're up against some great forces. Uh that we have to compete against. That makes this almost, a, a, seeming intractable. Problem. Gary what i found, so disturbing, about the hypertension. Uh uh data, is we can diagnose.
It We have effective, treatments, and they're not even expensive. I mean that's that's what's remarkable, i, i mean. Obesity, is so complex, i mean i you know i'm trying to lose 10 pounds it's hard. Um. But. But. Physicians, are good at hypertension. We can make the diagnosis. We can treat it and it is, inexpensive. Do you have a sense of what's happened over the last five years gary i mean you talked to so many people you fund so much research. Yeah i think um. One of the other elements. That you alluded, to. That i, uh i'd like us to, at some point. Give greater attention to is what some might call the science, of of health delivery. That is. As you point out it's not that the clinicians. Don't know what to do or don't have the tools. It does still raise the question as to, how. Effectively. Does our system. Control. A risk factor. And particularly. In those, who, quite frankly. Uh. Are on the lower, sexual economic. Means. Uh and and really i think it's more of an indictment, of our delivery. System. Less about our providers, and their knowledge. Uh than, anything. Uh similarly. It is a challenge. Uh in these communities, of color, in particular. Uh that, they have access. To the the. Uh lifestyle. That we know can promote. A. Healthy blood pressure. And so as griff was alluding, to. If you're in, neighborhoods. That don't. Provide access to fresh fruits and vegetables. And, yet have high concentrations. Of places, with high fat and high salt. Uh it's going to be harder. To have you're going to have more high blood pressure it's going to be harder to control. Uh so it's it's really a, multi-level. Multi-pronged. Element. Uh to this, now one of the things that we did fund uh, relatively, recently. Uh ron victor did a trial. Uh in which he actually, showed that, if you got into barber, shops, right. In these communities, of color. Uh, that indeed. That was a more effective. Way, of getting the word out, and getting the peer buy-in. Uh to controlling, blood pressure, uh and so uh, you you probably can't tell from my video that, uh black men spend a lot of time in the in in the barber shop and it's actually a major. Uh a conduit. Of information. Uh and so for him to leverage that for health education. In communities. Is again a strategy. Mobile technologies, have also been used so so there's still things we're trying to do, in terms of the science, of health delivery. That may make a difference. Now. I always, i always think of obesity. Trying, to. Help people. Who are trying to lose weight is just so. Remarkably. Complex. Griff. There isn't a drug i mean there is bariatric, surgery for people who are morbidly, obese, and. What defines, who should uh get surgery, is changing, i think. Because of the effectiveness. Of, of surgery but nevertheless, i i find it to be so much more complex. In some other medical, conditions. What do you think the future. Of trump trying to move towards better weight control for the entire, u.s population. Where do we need to go. Well i think you know, we clearly do have to think differently, i mean there are people, who are able to, um. If you look at, some of the behavioral, studies, that that nhlbi. And niddk. And the other institutes. And you know. Other agencies, that funded. It is quite clear, that, almost, anything, that you do as long as there's, good support, for it, uh and encouragement. And having people working groups. Uh in which there's group dynamics, to encourage, this, you will see that people will, lose weight, but after some. Point. It is absolutely. Clear. That. You know humans have evolved, to defend, weight loss, and. And a, number of compensatory. Mechanisms. Kick in. To, uh. Make it, you know more difficult, for you to lose the next incremental. Pound. Uh and in fact doing the same thing you begin to lose you begin to gain regain, weight. And. Under those circumstances. You know people can become quite discouraged, and they just give up and. And that weight just comes back but if you look at the series, of, of what happens. You know some people will, return. And, maintain, that weight loss, but the greater majority, will have a very slow slope, going back up at the, at the same, you know uh. Caloric. Intake, or reduced caloric, intake. So understanding. What those differences. Are. Uh, and again. Some of it is biological. Some of it is social. Uh and, and environmental. I think is something that we need to to, to to go after. You you do raise an important, issue and that is bariatric. Surgery, and i alluded, to this fact. That. Um. Kids. Youth, with uh obesity, is a great risk factor for type 2 diabetes. And they don't they're really refractory. To the therapies. That we use for adults. What seems to work. Is bariatric.
Surgery. Both in terms, of the, uh, the. Restitution. Of normal. Pancreatic. Function, and, insulin. Sensitivity. It also reduces. The the risk of of of, hypertension. And and cardiovascular. Risk factors. Uh but of course that's not something. That we want to prescribe, to large numbers, of, of, people out there. And so we're actively, involved, in studies. Trying to better understand. What are the. The biological. Underpinnings. Of why people, lose weight, and sustain, weight. And have sustained. Improvement, in, in metabolic. And cardiovascular. Parameters. After surgery, as you probably know. Many people begin to lose weight. You know, within, or at least their their metabolic. And, cardiovascular. Numbers, actually improve within hours or days, before they've lost substantial. Amounts of weight and, what it is intrinsically. That that's causing, that, is. Is is, yet to be determined, is probably, multifactorial. But we're actively. Uh. Engaged, in, supporting, and conducting, studies. To better understand, that, so that ultimately, people. May benefit. From bariatric. Surgery, without, having to undergo, surgery. Um. Yeah, i mean i i think of these as, almost like the twin evils. Uh, around population. Health, if, if you made me czar, helsar. I would say we're going to focus on two conditions, at the population. Level hypertension. And obesity. It is not lost. On people who are watching this. That. The two of you are black men in america. And, you, you touch on structural, racism. In, in the editorial, and i really appreciated. That you were willing to talk about that. Uh it's been a very painful, six months i, i, i can't really understand, what it's meant to black america, i can try. But i am not black. And so there's a long history of, slavery. And you touch on structural, racism. How do you, how do how did the two of you think about that. Visa, vis-a-vis, your institute. Personally. Vis-a-vis, hypertension. And obesity. Griff do you want to go first on this one. Yeah well as i think we alluded to it in in the uh in the viewpoint. Uh this is the context. Under which. People. Live, their their daily, lives, and so if you're in a, you know in an environment. Uh, that, doesn't have access, to fresh fruits and vegetables. Doesn't have a safe place for. For kids, and, and adults to to exercise. Uh, lacks resources. In terms of easy access. To, um. To healthcare, facilities. You know these have sort of a reinforcing. Effect, and and i think. Policies. And, uh. That. Or you that that have, been going on for years. Decades, perhaps. Uh, have. You know reinforced. This. Um. In terms of, of educational. Attainment. Employment, and attainment. And that's why i think you you mentioned, covet. This is brings this in short relief, because these same risk factors. And the same, things that put people in in these types of environments. Are also, risk factors, for. Being. Inability, to social, distance. To be our front line. Uh employee. Uh, that will be publicly, facing, and therefore a greater risk. Of of exposure. And then of course if they have, hypertension. Cardiovascular. Disease, diabetes. Obesity. They're at greater risk of suffering, more severe, complications. And, and even mortality. From the condition, so, i think you know this just puts this. You know uh, and the need to do something, uh at a more urgent, pace. Gary. How do you think about this.
Yeah No i uh. Griff, described, it quite well, i i think, um. You know we were. Cited a, a paper. That related, to redlining. Uh a, policy. Of, in essence disinvestment. Uh in areas that were, uh predominantly, african-american. Or communities, of color. And that's. Been in place for decades, but, kind of promotes, that racial segregation. Uh in our cardio, study the the cohort, study, uh it's been shown that, the individuals, who, uh were born in racially segregated, neighborhoods. And stayed in. Racially segregated, neighborhoods, had higher blood pressure over time. And so clearly. When we think about predisposing. Factors. Those social, dimensions, do what get under the skin and. They will show them that for example, that, those. Redlining, neighborhoods, also had, uh more pre-term. Uh uh, births. Uh and and that's where the the social. Potentially, has a biological. Underpinning. Because. We know how much. Your. The, the, seeds, of chronic, disease, whether it's obesity. Or hypertension, or cardiovascular, disease, begins, in utero. And so there are things if you're, born pre-term. The blood vessel vasculature. The elasticity. The elastin, that's laid down in your blood vessels is different. The stresses. That come from that that birth, both for mom, and child. Have that influence, and so. That starts to set up we know, your epi genome, and your microbiome. And everything. That then, puts you on a trajectory. Such that you may indeed have, uh, more of the 95th, or the 105th. Percentile. On your obesity, and blood pressure. So so all those things. Intertwine, both the social and the biological. And we're just now understanding, that the biological. Transduction. Of those social determinants, so. Those are things that, really work together. Uh and and reinforce. Uh these inequity. When you think you had mentioned before. That, the knowledge around hypertension. And had a diagnosis, and treat, treated as relatively, good. And, and. The highlight, the the muttner article really highlights. What we think is a failure in the delivery, side of care which i i i would agree i mean uh. For for me. Uh and i've written about this, everyone should have health insurance in this country to me that that is what we need to do and that would improve access, and in, in the mutton, article, regular, access to a physician, your blood pressure control was infinitely, better to me. Uh, this has to happen, in my lifetime, hopefully within a year or two. But when you think of, your institute, so both of you lead just remarkably. Influential. National, and international. Institutes. Uh, 80 90 percent of your friends, go to extramural. Funding. How do you think about, parsing, out those dollars, between. Lab-based, science, clinical, research. Um, do you do you feel like you need to move each of the institutes. In the direction, of delivery, or. Not where you want to go i'm just curious about, how you think about that i know you both have advisory. Boards. Um. Either one. I'm just curious about how you're thinking about. Giving this new knowledge, this funding. Gary you want to take that one. Okay, yeah. Hopefully. Look like we had a glitch there. We're back. Okay. Uh, so, um. So certainly, uh, we we. Several years ago started, uh, a, new, subunit, uh within the nhlbi. Called the center for translational. Research, and implementation. Science. Uh, and part of the reasons we did that. Uh, was, to, start to address. That sort of distal, end of what we call translational, research, everyone's. Familiar with bench to bedside. And and t1, and t2. As you get. Say a therapeutic, agent into, the clinic in the patient. Uh but it's that that, that, that end mile. Uh where, uh. You now need to go from efficacy. Uh toward making sure that uh, it. Reaches, patients, in the real world. Uh, uh where they live in the communities, and practices. Uh and and that's an area that uh i, think nih. Uh has not traditionally, invested, quite as much in. And so that's one of the commitments, we've made, that gets to the space of the science, of delivery. Uh and implementation. Science. Uh and and doing things again in a, rigorous, and systematic. Way. To test, strategies. Uh as an extension. Of what we do so. We've seen that as part of our mission. And it's still a, very, modest, part of our overall portfolio.
At The end the the engine, will almost always be discovery, science in the front end, uh and the clinical. Uh research, but we would like to see that more, seamless. I'm also hoping it dovetails, with, trends, in in healthcare, where i think. Related to the things that you do, here jama. Are talking more about value-based. Care and and really, looking at, things more holistically. As opposed to, per procedure. Per visit per se. And if we take that more holistic, view, i think that helps. Us think about, the patient at the center. Uh the community, in which they live, and how holistically. We can get better outcomes. Well. I mean the good news is that the nih, budget has really grown over the last three or four years from 32, 33, billion i i think next year it's supposed to top, 40 billion i hope some of those additional. Funds have flowed to your two institutes. Griff how do you think, how do you think about this balance, between. Discovery. Science. Which gary articulated. And and, sort of the back end you know t4. T5, sure. Yeah no absolutely, i mean i i. Completely, agree with his formulation. There and. Obviously, we think basic, science. Uh is, critically, important, because you really don't know. When the next. What that discovery. Is going to lead to five years from now 10 years from now and, and beyond, and so one has to have a a pretty good balance, of, basic science, trans. Translational. Work, and clinical, work and clinical, studies. Uh i just want to you know again, first. Echo, uh gary's, points but, but also, just maybe shift a little bit just to point out that we work together, and and the kinds of things that he's articulated. Is in both of our institute's, strategic, plans. Uh for the future. We're also realizing, that some of these seemingly. Intractable. Problems. Like obesity, and cardiovascular. Disease. Really, is gonna you know they don't occur, in isolation. So most people, who have hypertension. Also have diabetes. And they may be obese, and so, some of the things that we talk about. Um. That are in the environment. That may be conducive. To one may be conducive, to more than one, and we've taken this, opportunity. To to do these to. Fund these natural, experiments. And so for example, if there are policy, changes. Within a particular. City, or. Or district, or state. Or region. We use, an opportunity. Called a, time sensitive. Uh. Approach. To, allow people to apply, very early, in in advance, of these policy, changes. That um, to get baseline. Data, to see whether in fact. Once these policies. Are. Are, introduced. Over time whether that changes, not just one parameter. Say childhood, obesity. But whether that has an influence, for example, on, on hypertension. Or other things so for example. One could look at, the introduction, of light rail, systems.
Or. A decision, of a particular, school district. To allow, high school students to well of course not now, but to sleep in an extra hour before, the school start time. Or you may remember, a number of years ago. Uh when the, mayor of new york decided, that these jumbo. Uh other jumbo drinks. Drinks would no longer be allowed. Of course that was, actually overturned. But we actually funded some of those studies, so that investigators. Could get, information. Uh early on, the one final thing though is again we have to kind of go beyond, just working, together but we have to go across, agencies. So for example. We, we we've been, working, with, uh. In conjunction, with a number of institutes, at nhlbi. To work with for example, uh, housing, department. To see whether their voucher, programs, that put people in more affordable, houses, in different places. May have a health consequences. That one would predict. Based upon what we talked about the social determinants. Of health, so we're going to have to sort of work with other agencies, transportation. Education. Uh housing. Uh, and and and really conduct these these natural. Uh experiments. To see what these effects would be, yeah i've had a number of. Guests on the show who've. Decried, that we haven't, been better, at understanding. Natural experiments. And just trying to. And obviously, they're not clinical trials, but. Life isn't a clinical trial. And so. You can derive, an enormous, amount of, of information. As as you said and they're more likely to reflect the real world about what happens to someone's, life when you change the way they commute. Or they get to school, or what they drink or they eat. So. It's interesting, that. You've commented, on that specifically. Gary the gains in cardiovascular. Disease you've been at the nih, before, 2012, although that's when you became director, over the last 20 years or extraordinary. I i mean. Uh the late the number of live saves. The advances, in cardiovascular. Disease. But it appears to have plateaued. Over the last three or four, years. Um. Do you have a sense of why. Uh, it's plateaued, has it just gotten more difficult. Or. I've always thought, because it's been combined, with the obesity, epidemic, you've probably, saved many more lives but, it's hidden because of the obesity, epidemic. Do you have do you have a sense of why, we've we're seeing a plateau. In cardiovascular. Health. Well as you point out howard it's probably a bit multifactorial. As you say. We have a. An aging population. That also right, with a grading, a great uh increase, in some of the risk profile, of this, uh cohort. Uh with obesity and diabetes, as uh griff has alluded to. But i'm also concerned, that, uh if you look at some of the curves. Again there's a. Footprint, of, of geographic. Disparities. There as well that. The american, indian population. Uh, over the last uh, 20 years, is that is going getting worse. Um. They're parts of rural america, actually particularly, women. In low socioeconomic. Status in particular. In rural communities. Again african-americans. A a, a rather stubborn. Uh kind of decline if not a little bit of an upturn. So so some of that. Aggregate, curve, and plateauing. Uh sort of obscures, the fact that there's sub-populations. That are actually, going the wrong way as well as those, who are still benefiting. From a lot of the good progress, we're making, so again, it comes back to. One of the ways to get that curve going down, is to expand. Who gets the benefit, of all these advances. And ensure, that those who are getting a disproportionate. Burden. Get a disproportionate. Benefit. Uh related to what we know and that's going to take special, outreach. Uh in addition, i think. We we do need to get better, uh that uh. We need greater advances, and problems, like uh heart failure. Uh, uh and uh griff uh has, made uh, been a lot of great advances. But, uh there are things that um. You know. We still have too many people. Dying, uh with heart attacks.
Uh Even on statins, and and and. Uh state-of-the-art. Care, i i think we still need some breakthroughs. In how we can more effectively, arrest. Of this disease. And part of it i believe, is actually starting, earlier. That, we've always attacked, it as a affliction, of the elderly. I think we have to start. Now that we have new tools. Including. Apologetic, risk scores, and biomarkers. To say, should we start to intervene, earlier. Since we know this is an accumulative, effect of decade. Could we in fact, really shift that curve down, if we got more aggressive, earlier that that's more ambitious. Uh but but i think. Those are so many opportunities, i think still lay ahead. Gary you had mentioned sprint and jama had published you know the the major publications. Were split between jam and new england journal and, and, we published subsequently, two or three papers from sprint. Um, when you think of the scientific, describe. Discoveries. Uh. Funded by from, by your institute, in the last three or four years what do you think have been the major successes. And griff i'm going to ask you the same question i'm curious, when you think of the science, portion of your institute's. I mean, sprint was remarkable, i think it's settled the issue that you really want blood pressure. In the 120s. Not the 140s. But are there, there other things that come to mind, gary. That you think really represent, the next, the next generation, of science. Wow that's a tough one howard. It's like asking me which of my three children. Sorry. Don't answer that question. You have a lot of people listening. So so i already, put the chip out there on on sprint, uh because i, think that that one is remarkable. Uh in its scope and meaning and potential, public health impact not only in this country, but around the world. Uh it's really tough to to uh, uh to say uh as you also know i i think you, uh, share a certain uh, interest in what we're doing in the blood plate space. Sickle cell disease, yes you've written for us.
Uh And uh, again, and i think, the. The the. Very promising, initial, areas in terms of curing that and. My good friend griff is one of the leading. Investigators, in that space has been a pioneer, for, for decades, and so. That i think is very exciting, he mentioned, sleep, before. We actually are the host to the national center. For sleep disorder, research. At the nhlbi, it's really a trans nih. Initiative. Um, uh to to pardon the pun but i think that's the one the sleeper, areas, the sleeper. Errors of research, where. It has such broad, implications. And yet i think we're still. Just, scratching, the surface. For example. Uh finding, out how common, sleep disorder, breathing is in pregnancy. And how that's associated, with adverse. Uh sleep, uh out. Adverse pregnancy, outcomes. Including, pre-eclampsia. And and other uh sorts of disorders. And now we're doing an intervention. Uh to see that if you, improve, sleep uh, cpap, etc. Actually, help both mom and child. So those are very exciting, things that we're doing so. It would take you another three hours howard but uh just. That those are some examples. Griff, um. Niddk. Some great successes, i i i mean type one diabetes, type two diabetes, but i'm curious when you think of the science, portfolio. Over the last three four five years what emerges. As you think one of the great, great funding achievements, of niddk. Well, again, as uh. As gary mentioned, i we have so many. Different, constituents. And i you know i i hesitate, to say one is better, than the other but since you did mention type 1 diabetes. And it kind of segues, in into something, a comment that, gary just made, i think that's been one of the great success, stories. In two. Aspects. One is because. We have, um. Uh. Developed, a way. To sort of understand. The, genetic, risk of this. Probably. At this point just based upon, you know uh. Decades, of actually studying. You know the the, pre, existing, uh. Risk factors genetic risk factors for this, probably we know. More, about the genetic, risk, probably. You know somewhere around 85, to 90 percent. Of the attributable. Genetic, risk, is is known. Uh for, type 1 diabetes. And, and that has, therefore, led us to. Begin, to. Diagnose. Those, individuals, who are at extremely, high risk. And this has given us the appreciation. That the disease. Actually exists. Or the condition, exists. Before, people, develop, severe, dysglycemia. This is actually led to, to the development, of prevention, trials. One of which was reported, about a year and a half ago. Uh in which, you know just the the therapy, for, uh anti, cd3. Uh, has uh. Reduced, the, uh the development, of diabetes. By two years. Compared, to placebo. Uh in individuals, at extremely, high risk just think about that's two years, in which you don't have to check your blood sugar. Two years you don't have to give yourself, insulin, injections, your parents and sleep at night. Uh. That's a major accomplishment. But at the same time developing.
You Know these uh, uh artificial. Pancreas, technology. Which, again results from the confluence, of a number of, of, different. Basic science, discoveries. Translational. Work, bringing in computer, scientists. Mathematicians. With algorithms. To sort of put all this together, and something that. A pump will, will kind of use your iphone, or, other, you know, device. To calculate. And reproduce. The effects, of of what your kidney, does i mean what your what your pancreas, does, that has really been a a big benefit. And again i could, probably, give you. You know a, list of other conditions, but, i just want to say that that may be way, the the direction, of the future. In that we're going to be able to. Develop. A risk factor, score for people. And maybe, uh intervene. At people at extremely, high risk before the development. Of their disease. I wanted to make sure we finished on some positive. Uh, scientific. Information, since. The struggle around hypertension. And obesity, and obviously, the, the way it's influenced, coven. Covet 19 the pandemic. Uh particularly, for. For, uh, different, uh groups of individuals. Is so powerful. Um so i've been talking with, griff rogers, who's director, of uh. Niddk. And gary gibbons who's director of nhlbi. They've written a. An editorial, to accompany, two papers the title of, the editorial, is obesity, and hypertension. In the time of covet 19.. The papers are by paul muttner, and colleagues, trends in blood pressure control among u.s adults with hypertension. 1999. 2000, to. 2017-2018. Very concerning. Uh disappointing. Results. In the sense of, less control, now than, five years ago. And then by cynthia, ogden, and colleagues, a research, letter entitled, trenton obesity, prevalence by race and hispanic, origin, 1999. 2000, to 2017. 2018.. Uh gary and griff. I i want uh to thank both of you for joining me today. You direct just, remarkable. Uh institute. Institutes, and your leadership, in american medicine, is so critical, thank you for your remarkable, service over the last two decades. Well thanks for having us on the show really appreciate, it bye gary, bye griff, stay healthy. All right. Take care. Bye. You.