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NIH grant 1R01HL189164-01: Implementing tight blood pressure control in pregnant women with chronic hypertension
Institute: {'code': 'HL', 'abbreviation': 'NHLBI', 'name': 'National Heart Lung and Blood Institute', 'admin_org_id': '12500068', 'admin_funding_url': ''}. PI: DANDAN LIU. Award: $887207.
Start: 2026-09-05T00:00:00.
Chronic hypertension (CHTN) complicates 2-3% of pregnancies in the United States but accounts for a
disproportionate share of perinatal morbidity. Much of this morbidity is due to the elevated risk for developing
hypertensive disorders of pregnancy (HDP) like preeclampsia, which occur in 25-30% of women with
CHTN and are leading causes of maternal morbidity, maternal mortality, and preterm birth in the U.S. Both
CHTN and HDP are also associated with increased short and long-term risks for cardiovascular disease, which
may be mitigated through tight blood pressure (BP) control. The Chronic Hypertension And Pregnancy (CHAP)
study demonstrated that tight BP control – titrating antihypertensive medications to keep BPs below 140/90
mmHg – reduced the incidence of severe preeclampsia and indicated preterm birth. Major obstetric
organizations quickly adopted guidelines endorsing the findings of the CHAP trial, but real-world guideline
implementation has many challenges. Data from our clinical setting demonstrate that BP control improved only
slightly after institutional guidelines recommended tight BP control and this was not associated with improved
perinatal outcomes. Centralized management of pregnant women with CHTN has potential to improve BP
control and achieve guideline concordant care. Our preliminary data demonstrate that centralized management
of postpartum women with HDP using remote BP monitoring paired with BP coaching from a trained advanced
practice registered nurse improved BP control compared to clinician-directed care. We propose adapting this
model of postpartum care to the pregnancy management of high-risk women with CHTN using a pragmatic,
quasi-experimental study design. In Aim 1, we will conduct rigorous stakeholder engagement that tailors an
existing centralized postpartum HTN program to pregnant patients with CHTN. In Aim 2 we will evaluate the
effectiveness of a centralized program for HTN management in pregnant patients with CHTN using an
interrupted time series design to study whether implementation of centralized HTN care is associated with
improved hypertension control (lower systolic and diastolic BP, fewer visits with elevated BPs >140/90)
compared to clinician directed care. We will also evaluate key secondary outcomes including superimposed
preeclampsia, indicated preterm birth, placental abruption, and small for gestational age infants. In a subset of
100 patients (50 before, 50 after implementation), we will examine whether centralized HTN care decreases
changes in cardiac remodeling during pregnancy. In Aim 3 we will comprehensively evaluate the
implementation and impact of centralized CHTN management program for pregnant patients using the RE-AIM
framework. Our stakeholder-engaged approach will demonstrate that centralized management for pregnant
patients with CHTN improves BP control compared to clinician-directed care, and will generate critical insights
that enhance the dissemination, implementation, and sustainability in other care settings. This program has
potential to close nationwide healthcare gaps for pregnant women who do not have access to specialized care.document fetched 2026-09-13 02:46