The candidate for this K23 Mentored Patient-Oriented Research Career Development Award, Dr. Tammy Brady, is an Assistant Professor of Pediatrics at the Johns Hopkins University School of Medicine in the Division of Pediatric Nephrology. Her exceptional training and considerable research have prepared her well for this next phase in her career, which will result in her successful transition from highly skilled observational researcher to independent clinician scientist conducting clinical intervention trials Early in her training, Dr. Brady was awarded a Masters in Health Science in Clinical Epidemiology at the Johns Hopkins Bloomberg School of Public Health (JHSPH). During her training and early years on faculty she conducted multiple studies involving primary data collection and secondary data analysis. In addition to being co-investigator on several NIH funded multicenter studies, she has recently completed a year-long prospective, observational cohort study of 49 hypertensive children, entitled Longitudinal Study of Left Ventricular Hypertrophy Regression in Children with Primary Hypertension. As Principal Investigator, she obtained funding from several agencies to support this study: the National Kidney Foundation of Maryland, the American Society of Nephrology, the American Heart Association, and the National Institutes of Health/ Johns Hopkins Institute for Clinical and Translational Research. To date she has published 10 peer-reviewed original science articles, 4 as first author and one as senior author, and has three additional original science manuscripts to be submitted in the coming months (two as first author and one as senior author). Recognizing the value in additional training to further her research pursuits, she secured funding from the NIH/Johns Hopkins Institute for Clinical and Translational Research as a KL2 Clinical Research Scholar which allowed her to enroll full time in the Graduate Training Program for Clinical Investigation PhD program at the JHSPH. She received the NEMA Research Clinical Research Award at the completion of her first didactic year for receiving the highest score on the Comprehensive Examination. Since her initial K23 application, she has completed all of the required coursework for her degree and is scheduled to defend her thesis research on March 12, 2014. An essential component of her evolution into an independent researcher is hands-on mentored training in the development and implementation of a behavioral intervention and the design and conduct of a clinical trial. The research she proposes will accomplish these goals. With the known obesity epidemic in children contributing to the significant CV disease present in adults, prevention of obesity and other CV risk factors in childhood is of the upmost importance. The paucity of available strategies to enhance adolescent engagement in therapeutic lifestyle change, essential to correct the suboptimal learned behaviors contributing to this epidemic, is the motivation behind her current research proposal. Further, the widespread use of information technology, particularly cell phones among adolescents, presents an incredible opportunity to effectively and efficiently deliver lifestyle interventions to youth. Over the last several months, Dr. Brady conducted a pilot study of her proposed intervention among six adolescents with elevated blood pressure. This study, funded by the National Kidney Foundation of Maryland, provided her with rich qualitative and quantitative data regarding her proposed intervention. As a result, she is working with her mentors and Project Advisory Team to improve the messages delivered to participants and has enhanced her K23 research strategy using the knowledge gained from this pilot study. The overall objectives of this proposal are therefore to (1) test the hypothesis that a technology supported behavioral Healthy Lifestyle intervention is more effective than the standard of care on reducing adiposity, blood pressure (BP) and left ventricular mass (LVM) among obese, pre-hypertensive adolescents; and (2) compare the effects of the intervention on (a) hormonal regulators of blood pressure, growth, adiposity; (b) lipid risk factors; and (c) diurnal BP and BP variability among the same group of children. Dr. Brady will carry out this research in the rich training environment of Johns Hopkins University under the collaborative and supportive mentorship of Dr. Larry Appel, Dr. Pete Miller and Dr. Barbara Fivush. She will also work closely with the accomplished members of her Project Advisory team: Drs. Felicia Hill-Briggs, Ben Caballero, and Debbie Young; Ms, Jeanne Charleston; and Ms. Arlene Dalcin. These leaders in the field of epidemiology, clinical trials and behavioral medicine will ensure the successful completion of her proposed interventional trial. This mentored training, along with continued didactic training, will enable Dr. Brady to grow into an independent pediatric clinician scientist, designing and conducting clinical trials that will no only shape the care provided to children at increased CV risk but will also contribute to the expanding knowledge regarding the origins of disease.

Public Health Relevance

Despite the rising prevalence of obesity and known associated adverse effects such as high blood pressure, heart disease and elevated cholesterol, weight loss and adoption of heart healthy behaviors remains elusive for many obese children. Novel methods to engage, entertain and empower children to adhere to a heart healthy lifestyle will substantially improve our ability to prevent obesity and obesity-related complications in children.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZHL1-CSR-X (M1))
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Boyington, Josephine
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Johns Hopkins University
Schools of Medicine
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Shatat, Ibrahim F; Brady, Tammy M (2018) Editorial: Pediatric Hypertension: Update. Front Pediatr 6:209
Turer, Christy B; Brady, Tammy M; de Ferranti, Sarah D (2018) Obesity, Hypertension, and Dyslipidemia in Childhood Are Key Modifiable Antecedents of Adult Cardiovascular Disease: A Call to Action. Circulation 137:1256-1259
Brady, Tammy M; Stefani-Glücksberg, Amalia; Simonetti, Giacomo D (2018) Management of high blood pressure in children: similarities and differences between US and European guidelines. Pediatr Nephrol :
Eaton, Cyd K; Eakin, Michelle N; Coburn, Shayna et al. (2018) Patient Health Beliefs and Characteristics Predict Longitudinal Antihypertensive Medication Adherence in Adolescents With CKD. J Pediatr Psychol :
Habli, Mounira; Clifford, Corey C; Brady, Tammy M et al. (2018) Antenatal exposure to nonsteroidal anti-inflammatory drugs and risk of neonatal hypertension. J Clin Hypertens (Greenwich) 20:1334-1341
Medrano, Leah; Amatya, Kaushalendra; Vizthum, Diane et al. (2018) Association of mood disorders with cardiovascular disease risk factors in overweight and obese youth with elevated blood pressure. J Clin Hypertens (Greenwich) 20:1268-1275
Rinke, Michael L; Singh, Hardeep; Heo, Moonseong et al. (2018) Diagnostic Errors in Primary Care Pediatrics: Project RedDE. Acad Pediatr 18:220-227
Brady, Tammy M (2017) Obesity-Related Hypertension in Children. Front Pediatr 5:197
Brady, Tammy M; Townsend, Kelly; Schneider, Michael F et al. (2017) Cystatin C and Cardiac Measures in Children and Adolescents With CKD. Am J Kidney Dis 69:247-256
Sethna, Christine B; Meyers, Kevin E C; Mariani, Laura H et al. (2017) Blood Pressure and Visit-to-Visit Blood Pressure Variability Among Individuals With Primary Proteinuric Glomerulopathies. Hypertension 70:315-323

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