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Key Findings
  • The ATEMPT pilot trial demonstrated that remotely delivered antihypertensive treatment significantly reduced blood pressure in older adults with multimorbidity or polypharmacy, without increasing the risk of serious adverse events.
  • The successful implementation of a remote trial design in this underrepresented population supports the feasibility of future larger-scale clinical trials focusing on cardiovascular events, safety, physical functioning, and cognitive outcomes.
Future Direction

The main phase of the ATEMPT trial is planned after securing the funding to evaluate long-term effects on cardiovascular outcomes, cognitive function, physical activity, and serious adverse events.

Key Findings
  • Efficacy Across Populations: Blood pressure-lowering treatments significantly reduce major cardiovascular events, such as heart attacks and strokes, across diverse groups, including varying ages, baseline risks, and comorbidities. Even modest reductions yield substantial benefits for both primary and secondary prevention.
  • Personalised Strategies: Patients at higher cardiovascular risk benefit most from treatment, supporting tailored, risk-based approaches that maximise effectiveness and optimise healthcare resource use.
  • Policy Implications: Findings advocate for prioritising treatment based on overall cardiovascular risk rather than high baseline blood pressure alone, influencing global guidelines such as the 2024 ESC Hypertension Guidelines and promoting equitable access to care.
Future Directions
  • Identifying optimal medication combinations and long-term treatment effects.
  • Exploring risk-based patient selection to minimise adverse events and costs while maximising benefits.
  • Cost-effectiveness and economic analysis of blood pressure reduction strategies.
Key Findings
  • Risk Factors and Mechanisms:
    - Identification of genetic variants and metabolic pathways linked to early valvular degeneration.
    - Causal links established between VHD and cardiovascular risk factors like hypertension and lipid abnormalities.
  • Drug Repurposing:
    - Existing drugs with potential benefits for VHD identified using omics data and bioinformatics.
    - Digital trials facilitated by Zeesta are planned to evaluate the safety and efficacy of these candidates.
Future Directions
  • Validate drug repurposing candidates and expand understanding of VHD genetics and molecular mechanisms.
  • Identifying genetic, metabolic, and environmental contributors to disease onset and progression.

How we use machine learning

An AI Foundation Model for Patient Records

We've pioneered a new approach to analysing healthcare data by developing a foundation model that adapts Transformer AI technology for medical records. Our Bidirectional EHR Transformer (BEHRT) foundation model processes complex patient histories by integrating diverse health data points into a unified analysis, making unprecedented insights possible.

Risk Prediction

Our TRisk model, built as an expansion of the BEHRT foundation model, represents a significant advancement in preventive medicine. This system delivers superior accuracy in predicting cardiovascular diseases for both at-risk patients and those with existing conditions. For complex cases like heart failure, our foundation model achieves remarkable improvements in prediction accuracy compared to traditional methods.

Understanding Cause and Effect

We developed Targeted-BEHRT, another extension of our foundation model, to address one of healthcare's key challenges: understanding relationships between treatments and outcomes in patients with multiple conditions. This system excels at analysing complex medical histories where traditional approaches fall short of capturing multifactorial confounding and sources of selection bias. Through extensive testing in both controlled and real-world scenarios, we're enhancing our ability to make informed treatment decisions.

Patient Clustering

Our adaptation of the BEHRT foundation model uses contrastive learning to identify meaningful patient subgroups with greater accuracy than ever before. This approach has already led to important discoveries in understanding heart failure patterns and musculoskeletal conditions, enabling more targeted treatment strategies.

Related research themes