Project Summary:
Hypertensive disorder of pregnancy is a significant public health problem, especially postpartum. Affecting one in 10 pregnancies, hypertensive disorder of pregnancy is the leading cause of severe postpartum complications such as hemorrhagic strokes, heart failures, and deaths. Patients who survive these devastating complications face lifelong sequelae of cardiovascular disease.
The mechanisms behind the increased risk of cardiovascular disease are not yet understood. However, they involve vascular dysfunction generated by hypertensive disorder of pregnancy and worsened by persistent postpartum hypertension. Even though exposure to hypertension in the postpartum period is associated with an increased risk of chronic hypertension and cardiovascular disease, currently, postpartum treatment of mild hypertension is not recommended. The reason is that after giving birth, most women recover quickly and hypertensive disorder of pregnancy resolves. However, it takes longer for blood pressures to normalize in many women, and many remain hypertensive even one year after giving birth.
In addition, a lack of concrete guidelines for treatment may introduce biases and lead to a variation in healthcare delivery by race and ethnicity. This is especially important, knowing that in the past, pregnant and postpartum women received differential treatment based on race. Thus, it is critical to generate evidence to guide best practices for postpartum hypertension management. This will promote standardization of care and reduce variation in care and inequity seen with HDP. Another important barrier to optimal health after pregnancy complicated by hypertensive disorder of pregnancy is close postpartum follow-up to monitor blood pressure.
This project will utilize remote blood pressure monitoring and explore additional facilitators for postpartum follow-up. The researchers' ;central hypothesis is that continuous exposure to hypertension postpartum following hypertensive disorder of pregnancy is a key driving factor for medical complications and long-term risk of cardiovascular disease.