Current Ongoing Projects

Current Ongoing Projects

Population based stratagies for effective control of high blood pressure in Pakistan (Project Details)

Dr Tazeen Jafar, Dr Juanita Hatcher, 
Dr Mehtab Karim, Dr Nish Chaturvedi,
Dr Franklin White
Funded by: Wellcome Trust, UK
Amount: US $500,000
Duration: 2003-2006 

The study is aimed to assess cost-effective strategies for control of hypertension in Pakistan. The three-year investigator-initiated intervention project will use cluster randomisation and factorial design to assess the effect of  population-based health education by  community health workers on blood pressure levels of population aged five years or over (n=20,000), and cost effective management of blood pressure administered by intensively trained local general practitioners on adults.

Hypertension related damage to the microcirculation in South Asians: emergence predictive power and reversibility-an investigator-initiated study (Project Details)

Dr Tazeen Jafar (PI) (Medicine and CHS), Dr Juanita Hatcher (Co-I)
Funding Agency: Wellcome Trust, UK
Amount: US $300,000

The role of the microcirculation is increasingly being recognised in the etiopathogenesis of cardiovascular disease. Delays in this recognition are in part due to the difficulty of studying the microcirculation non-invasively, in large numbers of individuals. Retinal vessels provide an easily accessible "window" to the microcirculation. Abnormalities of the retinal vasculature have been shown to be associated with cardiovascular risk factors and all cause mortality. Non-invasive assessment of the retinal circulation presents a valuable opportunity to study the structure and function of the microvasculature.

Off-springs of patients with hypertension are more likely to have elevated blood pressure, and end organ damage has been shown to manifest during childhood. People of South Asian descent as compared to Caucasians have been shown to be more susceptible to metabolic syndromes predisposing to CVD, and also to end organ damage. The prevalence of hypertension has shown to be very high in Pakistan with one in three persons aged 40 years or over suffering from this disease. Development of non-invasive screening methods for detecting early signs of end organ damage beginning in childhood is of paramount importance for prevention of these dangerous diseases, and for understanding their etiopathogenesis.

This investigator-initiated study being launched by Aga Khan University's (AKU) Clinical Epidemiology Unit (CEU) on 2,400 subjects in 12 low income communities in Karachi is primarily designed to compare geometry of retinal microvasculature of 1) hypertensive vs normotensive adults, 2) children aged 10 to 14 years of hypertensive parent (test group) versus normotensive parent (control group), and, 3) to assess the impact of blood pressure lowering on these changes over 2 years. Retinal photographs would be taken and graded by research team members specially trained in standardised technique at Imperial College London, UK. Primary outcome would be abnormal retinal geometry defined as the composite outcome of a) abnormal arteriolar length: diameter ratios (a measure of relative arteriolar narrowing), b) narrowed branching angles (an indicator of arteriolar rarefaction), or c) disturbed junction exponents (a marker of endothelial dysfunction).

Molecular Genetics in Hypertension, Type 2 Diabetes and Coronary Heart Disease in Pakistan

Pakistan Side:
Principal Investigator: Tazeen H. Jafar, MD MPH
Co-Investigator: Philippe Frossard PhD

UK Side:
Principal Investigator: Tim Frayling PhD
Co-Investigators: Marc Caulfield MD, Nish Chaturvedi MD, Andrew Hattersley PhD

Total amount: US $540,000.00 over three years (January 1, 2007 - December 31, 2009)

The Wellcome Trust, UK, has awarded US $540,000 for an investigator-initiated study on "Molecular Genetics in Hypertension, Type 2 Diabetes and Coronary Heart Disease in Pakistan" to Drs Tazeen H Jafar (CHS and Medicine) and Philippe Frossard (BBS) at AKU in collaboration with researchers from University of Exeter and Imperial College London.

The aim of this project is to establish a large study of Pakistan subjects to identify the important genetic factors for hypertension, type 2 diabetes and coronary heart disease.

In addition to studying several polymorphisms, the study would also contribute to capacity building and transfer of technology via training of young researchers from AKU in leading-edge laboratory techniques in the UK (e.g. robotic techniques for DNA analyses), and in genetic epidemiology.

The current award is an excellent example of multidisciplinary research between the Departments of CHS and Biological & Biomedical Sciences, and adds a new dimension to the project, and reflects innovative approaches of collaborative thinking, which would contribute to tackling the enigma of chronic diseases in the Pakistani population.

Chronic Kidney Disease in the Pakistani Population-Estimation of Glomerular Filtration Rate (GFR)

Principal investigator: Dr Tazeen H. Jafar (Medicine/CHS)
Co-Investigator: Juanita Hatcher
Funding Agency: NIH Forgarty Grant
Amount: US $110,000
Duration: Three years (2007-2010)

The Indo-Asian developing countries are facing an epidemic of chronic diseases including hypertension, diabetes and chronic kidney disease (CKD). Diagnosis of early CKD is essential for institution of effective and timely prevention of its complications; costly late stage treatment for end stage renal disease is currently an unfeasible option in these populations. GFR estimates of kidney function provide a common reference standard for all people and are therefore readily applicable by physicians and understood by patients. However, the existing GFR equations yield widely discrepant results in the Indo Asian population, and none of the currently available estimating equations have been validated in this population. 

The study would be performed on 650 adult subjects from the general population in Karachi. A new GFR equation specific to a Pakistani population would be developed and validated using the gold standard of measured insulin GFR. The performance of the new equation will be compared to the existing ones developed in other populations. 

The project is likely to contribute significantly to moving the field of kidney disease forward, and its results are likely to have far reaching implications for understanding of CKD and, ultimately, its prevention in Indo-Pakistani populations worldwide.