Researchers from the Perelman School of Medicine at the University of Pennsylvania have embarked on a significant $12.5 million research initiative. The goal is to enhance postpartum blood pressure management and safeguard the long-term cardiovascular well-being of patients with hypertensive disorders during pregnancy. Postpartum hypertension is a major contributor to maternal complications in the United States, with Black women being disproportionately affected. Although most individuals with pregnancy-related hypertension recover completely, the condition can have lasting implications for heart health, elevating the risk of chronic hypertension, heart attacks, or strokes in later life. This study, funded by the Patient-Centered Outcomes Research Institute (PCORI), will concentrate on devising and assessing patient-centered strategies for more effective blood pressure management after childbirth. The aim is to mitigate disparities and improve outcomes for those at the highest risk.
Five hospitals across Pennsylvania, Ohio, and New York will take part in the 670-patient trial, known as Self-Monitoring and Responsive Technology for Postpartum Blood Pressure control (SMART Postpartum BP). Study participants with a history of hypertensive disorders in pregnancy will test two telemedicine-based strategies for postpartum blood pressure management. The “low-touch” approach will require patients to monitor their blood pressure at home for 10 days following childbirth, with healthcare professionals overseeing the data to address any concerning trends. The “high-touch” approach will involve 12 weeks of blood pressure monitoring, guided medication adjustments, and will also utilize pharmacists and nurses to take frequent blood pressure measurements.
“The leading cause of maternal complications is hypertension, yet many patients encounter difficulties in accessing care during the postpartum period,” stated the study’s principal investigator, Jennifer Lewey, MD, MPH, director of the Penn Women’s Cardiovascular Center and an assistant professor of Cardiovascular Medicine at Penn. “This trial presents an opportunity to enhance our care for patients during this crucial period and to address the long-standing disparities that impact maternal health outcomes.”
Statistically, Black patients and other patients of color have higher rates of life-threatening conditions such as preeclampsia. Additionally, they face greater barriers to accessing in-person care due to factors like childcare, transportation, and costs. Programs at Penn are alleviating this burden for all patients while addressing the root causes of inequity.
Penn Medicine has been at the forefront of postpartum cardiovascular care and maternal health equity, thanks to its forward-thinking, research-backed approaches that have become standard in Penn’s hospitals and clinics. One such intervention, developed over a decade ago by Penn’s Adi Hirshberg, MD, and Sindhu Srinivas, MD, is Heart Safe Motherhood (HSM) – a text-message-based blood pressure monitoring program for postpartum patients that has served as a national model. Patients are provided with remote blood-pressure cuffs, receive daily text reminders to check their blood pressures, and then send their results to their care teams who monitor the incoming data in real time. Physicians can then prescribe necessary medication, schedule same-day appointments, or direct patients to the emergency department as required to manage dangerous blood pressures. A 2023 longitudinal study of HSM involving over 1,000 participants revealed that patients who used HSM were less likely to experience seizures, strokes, emergency department visits, and hospital readmissions compared to those who did not.
By addressing crucial questions regarding postpartum blood pressure management, the SMART Postpartum BP study aims to improve long-term cardiovascular health, boost patient engagement, and reduce racial disparities. At one year postpartum, researchers will evaluate blood pressure control, heart function, and patient-reported outcomes such as stress and confidence in managing health.
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