Welcoming pediatric hypertension expert Tammy M. Brady, MD, PhD to Children’s National - Children's National

Tammy M. Brady, MD, PhD, joined the Children's National Hospital team this February.

After 21 years at Johns Hopkins Medicine, where she most recently served as the Vice Chair for Clinical Research in the Department of Pediatrics and Medical Director of the Pediatric Hypertension Program, Children's National is excited to welcome Dr. Brady and her vast knowledge in the fields of pediatric hypertension and clinical research.

Dr. Brady's previous research highlights her commitment to creating positive health outcomes for children. With expertise in hypertension, particularly obesity-related hypertension, blood pressure (BP) measurement, BP device accuracy and healthy lifestyle education, Dr. Brady will bring a unique and innovative set of expertise to the team.

"Our Nephrology division is very excited about the world-renowned clinical hypertension expertise that Dr. Brady will be adding to our team," Marva Moxey-Mims, MD, chief of the Division of Nephrology, said.

At Children's National, Dr. Brady joins the Center for Health Outcomes and Delivery Science and will lead the Grants Enhancement Program as well as a newly created Hypertension and Kidney Health Research Laboratory. Additionally, she plans to launch a new hypertension clinic, where she hopes to further study risk factors for cardiovascular disease in children.

"We are thrilled to welcome Dr. Brady to Children's National and the Center for Health Outcomes and Delivery Science community," Beth A. Tarini, MD and Monika Goyal, MD, co-directors of the center, said. "She brings deep expertise and a strong commitment to mentorship and collaboration. Her leadership will strengthen our ability to support investigators and advance research that improves the lives of children and families."

In a recent Q&A, Dr. Brady highlighted her research and professional background, along with her excitement stepping into her new role.

Q: How did your previous work prepare you for this role?

A: I have been so fortunate to train with and be mentored by the most amazing physician scientists who are not only experts in their field but are passionate about their work. Starting from residency when Dr. Joseph Flynn mentored me on my very first research project, investigating clinical and demographic predictors of increased cardiovascular disease risk in children, to working with Dr. Larry Appel and others on a suite of randomized clinical trials testing the importance of various steps on BP measurement accuracy, I have learned so much. I have personally conducted all aspects of clinical research, from manual chart review and data abstraction (with paper charts!) to recruitment and retention of pediatric participants in cross-sectional and longitudinal studies. These experiences have enabled me to be an effective research staff supervisor (I never ask staff to do anything I haven't already done!) and mentor.

In my former roles at Johns Hopkins, I focused on making research easier by helping trainees and faculty navigate every aspect of research, including study design, grant writing, budget development, funding acquisition, study implementation and results dissemination. I look forward to bringing this expertise to my new roles within the Center for Health Outcomes and Delivery Science at Children's National.

While I have also had significant didactic training in pediatric nephrology, epidemiology and clinical investigation, my "boots on the ground" experience in research and clinical care has had the greatest impact on my personal and professional development. Medicine and research are team sciences, and I strongly believe we are only able to provide the best care when we collaborate with others who bring different but complementary expertise and life experiences.

Q: You'll be helping to launch and lead a new hypertension program at Children's National. Can you tell us more about that vision? What is unique about this type of program?

A: The hypertension program at Children's National will be very family-focused, individualized and multidisciplinary. In addition to completing a full evaluation that includes "old school" BP measurements with a manual cuff and stethoscope according to clinical practice guidelines, each patient will undergo a thorough and personalized assessment to provide the correct diagnosis and evaluate for causes of hypertension and other conditions that could increase their cardiovascular disease risk.

All patients and their families will be counseled on learned heart healthy behaviors that preserve cardiovascular health. Habits like eating well, moving daily, getting good sleep, minimizing screen time, avoiding nicotine and minimizing stress are good for ALL people, with and without high BP. I often tell families: it's easier to learn a new behavior than unlearn an unhealthy behavior, so the earlier we promote healthy behaviors the better!

The hypertension program will incorporate established and emerging assessments to provide a robust picture of each child's cardiovascular risk. It will include out-of-office BP assessments through 24-hour ambulatory BP monitoring and home BP monitoring. It is key to know what a person's BP is like out of the office to eliminate any contribution of the "white coat effect" prior to embarking on an extensive evaluation and treatment plan. It will also incorporate heart imaging and measures of vascular stiffness and reactivity to paint a more holistic picture of their cardiovascular health. I will also be working closely with the Improving Diet, Energy and Activity for Life (IDEAL) Clinic seeing youth who are followed there and are found to have high BP. By seeing kids in concert with IDEAL experts, I hope to make things easier for families.

Q: Share a little about your research portfolio. What is your particular research passion?

A: I am very passionate about cardiovascular health promotion, and as such, that is where my research has focused. Early on, I investigated how to best determine which children with hypertension were more likely to have an early form of cardiovascular disease called left ventricular hypertrophy (LVH). This work revealed that obesity was a significant risk factor for LVH, and in fact, when I followed hypertensive children and adolescents over a 12-month period of time I found that those who gained weight were the ones who had their heart remodel in an unhealthy way, despite having good BP control.

I was awarded a National Institutes of Health grant to test the effect of a behavioral intervention using Instagram on weight and BP among children with obesity. Over six months, kids following the Instagram account gained less weight than those who were in the control group - suggesting that increased touch points and check ins can improve cardiovascular health. This led me to develop an obesity hypertension clinic to not only take better care of children with obesity and hypertension in the here and now - with more frequent follow up and multidisciplinary care - but also to serve as a means to learn how to take better care of children in the future.

All the children in this clinic were invited to join a clinical research registry which led to more discoveries: sleep apnea, anxiety and depression are highly prevalent in kids with obesity and hypertension - and when present, amplify the risk for high BP and LVH. I also discovered that many triage BPs - the ones taken prior to seeing the doctor - were inaccurate in youth with obesity. Because so many decisions are often made based on these measurements, optimizing triage BP measurement is key to improving clinic efficiency and minimizing unnecessary follow up and evaluation in children who have a high BP related to technique.

My latest efforts have focused on exploring the importance of established BP measurement steps on measurement accuracy. I led four randomized trials in adults to determine how important it is to rest for five minutes prior to BP measurement, to have BP measured in a quiet, private setting, to select a cuff size based on measured arm size, and to rest the arm on a table next to you positioned with the cuff at heart level. We tested these conditions because these are steps that are often not followed and add a significant amount of time to the measurement procedure, impacting clinic flow. We found that for adults without high BP, there is (a) no need to wait prior to measurement, (b) a loud, non-private measurement setting doesn't significantly impact BP accuracy, (c) it is essential to select the correct cuff size, as choosing too small a cuff can overestimate BP by up to 200mmHg, and (d) having the arm rest on a desk makes a difference, as not adhering to this can overestimate BP by almost 10 mmHg. I am now hoping to test these conditions in kids - the easier we make BP measurement, the more kids we will be able to effectively screen for high BP!

Q: What stood out to you when deciding to join Children's National? And what are you most excited to bring to your new role?

A: What made me most excited to join Children's National are the people. Not only are there phenomenal physician scientists here, but every single member of the Children's family has been so kind, welcoming and committed to providing excellent care to the children and families we serve.

The opportunity to work with Drs. Goyal and Tarini is a dream. They not only conduct meaningful, practical, creative and impactful research, but they are visionaries. I am excited to collaborate with them in the center and learn from them as I grow the Grants Enhancement Program. Similarly, I am so excited to work with Dr. Moxey-Mims. She is a tireless advocate for children with kidney disease and has expansive expertise in how to conduct meaningful clinical research in this population.

Q: What keeps you passionate about the work you do?

A: The families who trust me to care for their children. The relationships I have formed with my patients along with the opportunity to celebrate their successes and guide them through their challenges is something I cherish. Learning what is important to the families I care for allows me to focus my work in a way that it is impactful for them.

I also just really love clinical research. One of my favorite things to do is meet with trainees and junior faculty, learn about what their clinical and research interests are, and then start drawing conceptual models and directed acyclic graphs. I won't even get into the thrill I get from writing Stata code - it's all really just so much fun.

Q: Last question - what do you like to do with your time outside of work?

A: I love travel, live music, Boston College football games and FaceTiming my kids.