Throughout my career, I have designed studies, reported results and defended positions that made the fields of research, in which I was active, move forward.

Self-evaluation of contribution to research fields

The Systolic Hypertension in Europe Trial (Lancet 1997; 350: 757-764) provided the scientific evidence showing that older patients with isolated systolic hypertension needed to be pharmacologically treated. This landmark trial also provided the first evidence that calcium-channel blockers were safe blood pressure lowering drugs. It ended the controversy in the 1990s that this class of antihypertensive drugs might have adverse effects (Eur. Heart J. 2000; 21: 2-7). The meta-regression analysis, which I published in 2001 (Lancet 2001; 358: 1305-1315), proved that blood pressure reduction rather than the type of antihypertensive medication is the main determinant of cardiovascular outcome in treated hypertensive patients. The Blood Pressure Lowering Treatment Trialists’ Collaboration, in which I took part, subsequently confirmed this conclusion (Lancet 2003; 362: 1527-1535). The clinical studies, I was directly involved in, and my quantitative overviews of randomised clinical trials in hypertensive and high-risk patients (J. Hypertens. 2003; 21: 1055-1076) directly contributed to the 2003 guidelines for the management of hypertension issued by the European Society of Hypertension (J. Hypertens. 2003; 21: 1011-1053).

In my 1997 publication (JAMA 1997; 278: 1065-1072), I demonstrated that the 24-hour ambulatory blood pressure is a better predictor of cardiovascular outcomes than conventional blood pressure readings at the clinic. Current guidelines for the management of hypertension both in Europe (Eur. Heart J. 2007; 28: 1462-1536) and in the United States (Hypertension 2003; 42: 1206-1252) recommend diagnostic thresholds for the ambulatory blood pressure (J. Hypertens. 1994; 12 (suppl 7): S1-S12) and the self-measured blood pressure at home (Arch. Intern. Med. 1998; 158: 481-488), which I first published in the 1990s. I led an international consortium of researchers in the construction and analysis of the International Database of the Ambulatory blood pressure in relation to Cardiovascular Outcome (IDACO). Recent analyses of the IDACO database proposed new thresholds for optimal, normal and elevated blood pressure levels on ambulatory monitoring, which for the first time were based on cardiovascular risk (Circulation 2007; 115: 2145-2152) rather than distributional characteristics. IDACO also generated more details on the prognostic significance of the daytime and nighttime blood pressures and the night-to-day blood pressure ratio (Lancet 2007; 370: 1219-1229). In collaborative research with other groups in China, Denmark, Ireland and Japan, I recently proposed and validated the Ambulatory Arterial Stiffness Index, as a measure of arterial stiffness, which can be easily derived from 24-hour ambulatory blood pressure recordings (Hypertension 2006; 47: 359-364).

In my environmental research, I demonstrated that low-level environmental exposure to lead affects glomerular renal function (NEJM 1992; 327: 151-156). I showed for the first time that environmental exposure to cadmium causes osteoporosis, not only via renal tubular dysfunction leading to increased calciuria, (Lancet 1994; 343: 1523-1527), but also via a direct osteotoxic effect (EHP 2008, Epub ahead print). I first reported that environmental exposure to cadmium increases the risk of fractures (Lancet 1999; 353: 1140-1144), especially in postmenopausal women, and the risk of lung cancer (Lancet Oncol. 2007; 7: 119-126). In my own country, my environmental research made a difference for the inhabitants of the areas contaminated by heavy metals, because they made the Flemish Government to rule that sites contaminated with cadmium or lead needed redevelopment. I validated the use of biomarkers of exposure and effect in adolescents to monitor environmental pollutants (Lancet 2001; 357: 1660-166).

Ability for interdisciplinary research

In 1998, I started the European Project on Genes in Hypertension in 4 Eastern and 2 Western European countries (Curr. Hypertens. Rev. 2006; 2: 275-281). In this study, we implemented the standardised epidemiological methods, which I pioneered since 1985 in our Flemish population study (FLEMENGHO). For these studies, I wrote the manuals of operation, codebooks, and SAS programmes for compilation of the data. I developed the programmes to convert questionnaire replies and codes into analysable variables. The EPOGH consortium continued to collaborate beyond the formal end of the project in 2002, in particular within the framework of two larger European networks (InGenious Hypercare and HyperGenes). Within these networks, in a multidisciplinary approach, I collaborate(d) with basic researchers and geneticists, trying to find the pathophysiological pathways and molecular mechanisms underlying some of the observations that I had made in my epidemiological research. In collaboration with Professor Bianchi’s group (Milan, Italy), we published the first prospective population-based studies, showing that variation in the genes encoding the angiotensin-converting enzyme (ACE I/D) and α-adducin (Gly460Trp) are associated with an increased risk of hypertension and hypertension-related cardiovascular complications (Hypertension 2007; 49: 1291-1297). In molecular experiments, we identified higher membrane-bound ACE activity as the most likely underlying mechanism. Along similar lines, we published epidemiological results alongside with experimental data on the role of genetic variation in the regulator of G-protein signalling-2 (RGS2) in the metabolic syndrome (J.Hypertens. 2007; 25: 117-125).

Coaching young researchers

Using the same standardised epidemiological methods as those implemented in FLEMENGHO and later in EPOGH, I helped my research fellows to start their own epidemiological studies in China (Drs. Ji-Guang Wang, Yan Li and Haifeng Zhang; Hypertension 2007; 50: 333-339) and in South Africa (Drs. Elena Libhaber, Muzi Maseko, Cleopatra Shiburi and Angela Woodiwiss; J. Hypertens. 2007; 23: 1798-1806). From 2003 until 2007 (see http://www.staessen.net/researchunit.html), I hosted 37 researchers in my group visiting from China (5), Poland (13), Portugal (1) South Africa (5), Denmark (1) Switzerland (1), Japan (1), Italy (1), Uruguay (1), Spain (2), the Netherlands (2), the Czech Republic (1), the Russian Federation (2), and Estonia (1).