Meet the researcher: Dr Tarek Antonios

Published: 19 November 2019

What is your main area of focus?

I run the hypertension service (Blood Pressure unit) at St George’s Hospital, so I get many referrals of patients with very high blood pressure. My area of research at the University is focused on investigating the origins of hypertension, especially the role of small blood vessels and abnormalities that can cause hypertension.

Recently I have been looking at individuals with high blood pressure and their children. We found that they have a condition called rarefaction, which is a reduction in the density of capillary blood vessels. I wanted to find out if this condition is caused by the high blood pressure or is a cause of it. So, we looked at young adults with normal blood pressure whose parents had hypertension and we found that they have capillary rarefaction. In order to prove that capillary rarefaction can cause hypertension in later life we needed to follow these young adults for a life time.

How are you carrying out your work?

I decided the best way to find this out would be to study pregnant women with high blood pressure. These women can go on to develop a condition called pre-eclampsia, which can have dangerous outcomes for the baby and mother. 

We found that if you measure the degree of rarefaction in these women, you can predict who will go on to develop pre-eclampsia before the increase in blood pressure. We also did a small study in babies born to mothers with pre-eclampsia, and found that some have capillary rarefaction at birth, which increases the risk of high blood pressure and diabetes in later life.

We’re able to measure rarefaction by looking at the skin or under the tongue. I have several different machines to do this, including one that I’ve invented in collaboration with the Enterprise and Innovation office of SGUL (iCAPPPS machine). Measuring capillary rarefaction using this machine is by far the best predictor of pre-eclampsia we have, with about 77% accuracy.

The theory is, that if we know when it’s going to happen we can prevent it happening, and use this information to help us prevent hypertension.

What are the risks of pre-eclampsia?

It depends on the country. In the western world, there’s much lower mortality because mothers have much closer contact with their midwives and doctors. Whereas in some countries there’s little or none, and women only present when it’s too late. If women can be seen early in pregnancy, before 20 weeks, when pre-eclampsia may start, we can predict it better.

We also know that the risk of high blood pressure and heart disease is about four times higher for women with a history of pre-eclampsia and also their children, but no one knows why. This is why I’m looking into this.

How did you become interested in this area?

I became fascinated when I did my master’s degree, looking at patients with angina, diabetes and hypertension. I did research in this area and found that we don’t know why these groups get high blood pressure. My work is starting to confirm that it might be small blood vessel changes that are causing hypertension in later life.

What are you looking at next?

I’ve received funding from the British Heart Foundation to follow up babies born to mothers with normal blood pressure, high blood pressure and pre-eclampsia until they are adults (G-CROS study). We think there’s something that causes the children to develop rarefaction after the first year of life. This funding will allow us to follow 390 infants for many years to try and work out what’s going on.

I’m also planning to get funding to do a bigger study with the iCAPPPS machine I’ve invented to predict pre-eclampsia. We need to be able to validate the results to be able to get it into clinical practice.

My aim is to get this machine in clinical use, so it can be used in every antenatal clinic.

What motivates you?

I love my work as a hypertension specialist, and the blood pressure unit is a recognised Centre of Excellence by the European Society of Hypertension. I need to know why these people develop hypertension in the first place. If I can find something to prevent it, that would be a major achievement for me.

Do you have any hobbies outside of research?

My main hobby is underwater photography. I have a huge collection of very nice pictures that I’ve taken underwater. I usually go to the Red Sea, which I think is the best place for diving, but I’ve been to the Bahamas, the Seychelles, and Saudi Arabia too. At the moment I try and go at least once a year.

I love gardening as well. I’ve been giving out plants to other researchers at St George’s. If you see any more around the department, they’re my plants.