The pharmacology professor: Morris Brown

Professor Morris Brown is Professor of Clinical Pharmacology, University of Cambridge, and Consultant Physician at Addenbrooke’s Hospital.

My aim is to protect people like Ian from the effects of high blood pressure. I meet people with this every day, some as young as 18. Finding better ways to treat it could reduce heart attacks and strokes worldwide. I’m currently collaborating with colleagues in eight other UK centres on a project to determine which treatment pathways are best for different groups of people:

Pathway one

This is for people with newly diagnosed hypertension who haven’t taken any blood pressure-lowering drugs before. We’re trying to determine whether we should routinely start newly diagnosed people off on two drugs from the outset rather than starting them on one drug and only introducing a second if the first isn’t effective enough. We suspect that after 12 months a person’s condition will be better controlled if they take two drugs from the outset.

To achieve this, we’ll recruit 600 patients and divide them randomly into three groups, each receiving two tablets. In one group, the tablets will be losartan and a water tablet (diuretic); in the other groups, only one of the tablets will be an active drug – either losartan or the diuretic – and the other pill will be a dummy pill. After four months, all patients will receive both drugs.

The question is: at the end of a year, will blood pressure be lower in those who started on two drugs?

Pathway two

This involves 350 people with resistant hypertension, which means their blood pressure still isn’t under control despite taking several drugs. The standard drugs used to treat hypertension are ACE inhibitors, beta blockers, calcium channel blockers and diuretics.

Patients with resistant hypertension are usually taking an ACE inhibitor, a calcium channel blocker and a diuretic. So we ask the people taking part in this pathway to keep taking their usual medicines and then we add in a fourth drug. The options for the fourth drug are a beta blocker called bisoprolol, an alpha blocker called doxasozin, a diuretic called spironolactone and a dummy pill.

Participants will be given one of the four optional drugs on a rotational basis, so by the end of the trial everyone will have taken their regular medicine and each one of the four new drugs for three months at a time.

We then monitor their blood pressure while they are taking each new drug to see which combination is best. We also measure their kidney hormone, renin. We believe that the amount present in their blood will predict which of the three additional drugs will be most effective in individuals.

If our predictions are right, it could help doctors to decide which drugs are best for their blood pressure patients rather than using the current method of trial and error.

Pathway three

This includes 500 people with hypertension who also have a lot of weight around their middle, increasing their risk of diabetes.

There’s been some concern that some types of diuretics – the type that lower potassium in the blood – can increase diabetes risk. As a result, many doctors are reluctant to prescribe them for some people, which may mean those people develop resistant hypertension.

Our study is examining the effect of a potassium-sparing diuretic, alongside someone’s regular drugs, to see if it can lower blood pressure without increasing diabetes risk.

Watch our film featuring Morris Brown's work on a scan for Conn's syndrome, a cause of hypertension. (You may need to log into Heart Matters first.)

Read our introduction to high blood pressure

Read about Mark Caulfield's research into genetic causes of hypertension

Read about Chris Bulpitt's research into hypertension in the elderly

Read about patient Ian Thomson's story