Driving down postpartum high blood pressure

PHILADELPHIA—Researchers at the Perelman School of Medicine at the University of Pennsylvania are launching a $12.5 million study to improve postpartum blood pressure management and long-term cardiovascular health for patients with hypertensive disorders during pregnancy. Postpartum hypertension is a significant cause of maternal complications in the United States, with Black women disproportionately affected. While most individuals with pregnancy-related hypertension recover fully, the condition can have lasting effects on heart health, increasing the risk of chronic hypertension, heart attack, or stroke later in life. The study, funded by the Patient-Centered Outcomes Research Institute (PCORI), will focus on developing and evaluating patient-centered strategies to better manage blood pressure after delivery, aiming to reduce disparities and improve outcomes for those at highest risk.

Five hospitals across Pennsylvania, Ohio, and New York will participate in the 670-patient trial, called Self-Monitoring and Responsive Technology for Postpartum Blood Pressure control (SMART Postpartum BP), will involve study participants with a history of hypertensive disorders in pregnancy will test two telemedicine-based strategies for postpartum blood pressure management: A “low-touch” approach will have patients monitoring their blood pressure at home for 10 days following childbirth, with monitoring by healthcare professionals to address any concerning trends; a “high-touch” approach will involve 12 weeks of blood pressure monitoring, guided medication adjustments, and also utilize pharmacists and nurses to take frequent blood pressure measurements.

“Hypertension is a leading cause of maternal complications, yet many patients face challenges in accessing care during the postpartum period,” said 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 provides an opportunity to improve how we care for patients in this critical period and to address the longstanding disparities that affect maternal health outcomes.”

Ending Unacceptable Inequity

While Black patients and other patients of color have statistically higher rates of life-threatening conditions like preeclampsia, they also have higher barriers to accessing in-person care due to childcare, transportation, and costs. Programs at Penn ease that burden for all patients while addressing inequity at its roots.

Penn Medicine has been a leader in postpartum cardiovascular care and maternal health equity thanks to the forward-thinking, research backed approaches that are now standard at 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 become a national model. Patients are given remote blood-pressure cuffs, are texted daily reminders to check their blood pressures, and then are required to send their results to their care teams who monitor the incoming results in real time. Physicians are then able to prescribe necessary medication, schedule same-day appointments, or alert patients to go to the emergency department, whatever is necessary to put dangerous blood pressures in check. A 2023 longitudinal study of HSM that included over 1,000 participants found that patients who used HSM were less likely to experience seizures, strokes, emergency department visits, and hospital readmissions compared to patients who did not use HSM.

By addressing key questions about postpartum blood pressure management, the SMART Postpartum BP study aims to improve long-term cardiovascular health, enhance patient engagement, and reduce racial disparities. At one year postpartum, researchers will assess blood pressure control, heart function, and patient-reported outcomes such as stress and confidence in managing health.

“Programs that allow patients to monitor their blood pressure from home represent a promising solution to one of the most pressing challenges in postpartum care,” said Lisa Levine, MD, MSCE, Director of Penn’s Pregnancy and Heart Disease Program and co-principal investigator of the study. “This study not only seeks to identify the most effective strategies but also examines how we can ensure equitable care across all populations.”

Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, excellence in patient care, and community service. The organization consists of the University of Pennsylvania Health System and Penn’s Raymond and Ruth Perelman School of Medicine, founded in 1765 as the nation’s first medical school.

The Perelman School of Medicine is consistently among the nation's top recipients of funding from the National Institutes of Health, with $550 million awarded in the 2022 fiscal year. Home to a proud history of “firsts” in medicine, Penn Medicine teams have pioneered discoveries and innovations that have shaped modern medicine, including recent breakthroughs such as CAR T cell therapy for cancer and the mRNA technology used in COVID-19 vaccines.

The University of Pennsylvania Health System’s patient care facilities stretch from the Susquehanna River in Pennsylvania to the New Jersey shore. These include the Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center, Chester County Hospital, Lancaster General Health, Penn Medicine Princeton Health, and Pennsylvania Hospital—the nation’s first hospital, founded in 1751. Additional facilities and enterprises include Good Shepherd Penn Partners, Penn Medicine at Home, Lancaster Behavioral Health Hospital, and Princeton House Behavioral Health, among others.

Penn Medicine is an $11.1 billion enterprise powered by more than 49,000 talented faculty and staff.