Robert N. Peck   Assistant Professor

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My research focuses on the unique epidemiology and pathophysiology of cardiovascular disease in adults and children in Africa and on interventions for prevention and treatment of hypertension. I conduct my in Tanzania in partnership with the Weill Bugando School of Medicine and the London School of Hygiene and Tropical Medicine’s “Mwanza Interventions Trial Unit” (MITU). In addition to my research, I have also directed the collaboration between WCM and Weill Bugando since 2007.

My early work focused on describing the morbidity, epidemiology and mortality of hypertension in Africa. I documented the growing burden of hypertension and hypertension-related diseases in young adults in Tanzania. In a population-based survey of 1,000 community-dwelling young adults in Tanzania and Uganda, we confirmed a high prevalence of hypertension. Infectious diseases have traditionally been considered the main cause of morbidity and mortality in Africa. However, in a 3-year prospective study of adults admitted to Weill Bugando, I documented that hypertension-related diseases are now the 2nd leading cause of hospital admissions (after HIV), accounting for 20% of hospital days and 20% of in-hospital mortality. More than half of the adults who died from complications of hypertension were under the age of 60 years. Subsequent work documented that even adults who survived hospitalization for hypertension had poor outcomes - 30% died within one-year.

I also conduct research to improve prevention and treatment for hypertension. I participated in the 5-year, binational “Improving Health Services for Chronic Diseases in Africa” project. This study concluded with a cluster-randomized clinical trial demonstrating that the quality of clinical care for hypertension and diabetes can be dramatically improved when health systems for continuing education, monitoring and evaluation, and drug supply are strengthened. This trial involved 80 sites in Tanzania and Uganda. We are now planning for a step-wedge implementation trial to confirm the real-world effectiveness of this intervention.

I also investigate possible causal links between infections and hypertension in Africa. In 2014, I reported a significant association between HIV and hypertension in African adults. I found that the prevalence of hypertension in Tanzanian HIV-infected adults on antiretroviral therapy (ART) was 30%, two-fold greater than HIV-negative adults and six-fold greater than HIV-infected adults not on ART. I have hypothesized that a reconstituted immune system is necessary for the development of hypertension in HIV-infected adults and am testing this hypothesis in a cohort of 500 HIV-infected and 500 matched, HIV-uninfected controls. My work has also illuminated a possible causal link between childhood schistosomiasis and hypertension in young adults.


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