Research

The University of Wisconsin-Madison's Prevention Research Center is adapting the Staying Healthy After Childbirth (STAC) program as the UW PRC Core Research Project for 2024-29. As principal investigator, Dr. Hoppe will work with the PRC to expand her current remote patient monitoring program to deliver the benefits of STAC to community-based organizations within Milwaukee and Dane County, to reduce racial disparities in postpartum hypertension, and improve cardiovascular health overall. 

PRC Core Research Project in the News: 

• Blood pressure program hopes to reach more new mothers in Dane, Milwaukee counties - Wisconsin Public Radio
• Blood pressure monitoring program for new and expectant mothers to expand - WKOW
• Maternal health monitoring program expanding through research project - WisBusiness
• UW gets $5 million to improve health for pregnant Black women and their babies - Wisconsin State Journal
• Blood Pressure Program Monitors New Mothers in Milwaukee, Dane Counties - Urban Milwaukee
• UW Health expanding maternal blood pressure program - WBAY

Staying Healthy After Childbirth-My Hypertension Education And Reaching Target Postpartum (STAC-MyHEARTp)

What is STAC?

Staying Healthy After Childbirth (STAC) is a program that helps new moms with high blood pressure safely monitor and treat their high blood pressure from the comfort of their home. We send people home with special equipment that allows for daily remote monitoring and the ability to interact in real time with health care professionals to guide and support them through six weeks after delivery.

What is MyHEART?

MyHEART stands for the My Hypertension Education and Reaching Target program, and its goal is to share information with young adults to help them live a healthier life, lower their blood pressure, and prevent heart disease. 

The MyHEART research program focuses on increasing young adult self-management skills to promote heart healthy choices and lower blood pressure. It is a theoretical based health coaching program tailored to young adults with hypertension, and includes four evidence-based self-management components:

• Telephone-based health coaching with adult education specialists to teach and monitor self-management skills
• Electronic health record documentation of coach-patient telephone contacts
• Individualized hypertension education materials
• Home blood pressure monitoring

Who can participate in the STAC MyHEART-p study?

Participants will enroll in the study towards the end of their participation in STAC and continue with the program for approximately 12-months postpartum.

Why is this study important?

Postpartum hypertension is a common problem, especially in those people who experienced hypertension during their pregnancy or have chronic hypertension. As many as 30% of people with hypertension during pregnancy and chronic hypertension still experience persistent hypertension that may still require treatment with a medication beyond 6-weeks postpartum.  Hypertension during pregnancy can become permanent and lead to long-term adverse cardiovascular health outcomes.

Brief Summary of the STAC MyHEART-p study:

The study, Staying Healthy After Childbirth (STAC) and My Hypertension Education And Reaching Target (MyHEART) for postpartum (p) patients will determine if health coaching can increase 12-month postpartum care attendance, hypertension control and hypertension self-management behavior compared to usual clinical care in patients with chronic hypertension or persistent pregnancy associated hypertension - postpartum. 140 participants (70 in each study group) will be enrolled and can expect to be on study for 12 months.

The program will attain these goals through a multi-component, patient-centered, theoretically-based intervention designed to increase self-management using evidence-based health behavior approaches to lower blood pressure and improve long-term outcomes. To do this, the 12-month program provides:

• Personalized health coaching with a specialist to teach and monitor self-management skills;
• Daily, home blood pressure monitoring;
• Participant surveys cataloguing lifestyle aspects and nutrition, and
• EMR analysis for tracking changes over 12-months postpartum.

If you are interested in learning more about the STAC-MyHEARTp program or want to see if you are eligible to participate, please contact the study team at STAC-MyHEARTp_obgyn@wisc.edu or call 608-556-9708

ClinicalTrials.gov Identifier: NCT05685251

Pregnancy as a Window to the Future: Outcomes of Antihypertensive Therapy and Superimposed Preeclampsia in Pregnant Women with Mild Chronic Hypertension 

An extension of the CHAP (Chronic Hypertension and Pregnancy) study, this multi-site trial aims to continue tracking the original cohort of participants to assess the impact of treating mild chronic hypertension during pregnancy on maternal cardiovascular disease (CVD) risk. The study will also evaluate the long-term effects of superimposed preeclampsia on the development of CVD. By following these patients over a prolonged period, the project seeks to better understand how pregnancy-related hypertension disorders influence long-term maternal health and inform strategies for presenting CVD in affected individuals. 

Offspring Neurodevelopment and Growth after Early Antihypertensive Therapy or Preeclampsia in Women with Chronic Hypertension and Pregnancy 

This observational multi-site trial aims to evaluate long-term child outcomes in children born to original CHAP (Chronic Hypertension and Pregnancy) participants diagnosed with mild chronic hypertension who received antihypertensive therapy during pregnancy or had preeclampsia. The study will compare long-term outcomes, including neurodevelopment and growth, to further understand the impact of maternal hypertension on child health. 

Marani Health is collaborating with Dr. Hoppe to evaluate the M•care System in remote management of pregnant patients’ health. This project focuses to connect providers directly to their pregnant patient’s vital health and wellness information. Dr. Hoppe and the STAC nursing team are working within the UnityPoint-Meriter system to assess the system’s effectiveness in managing both patients with and without hypertension disorders of pregnancy during the antenatal and postpartum periods. The goal is to improve patient outcomes by enabling timely interventions and better management of hypertension, both during and after pregnancy.

Advancing postpartum care for Black women in Wisconsin by engaging community partners with a home telehealth service for hypertension– a feasibility project

Black women in Wisconsin and nationwide have significantly higher likelihood of HTN in pregnancy compared to white women. This study aimed to expand the current remote monitoring program (STAC) to incorporate community partnerships to offer postpartum care that included lactation, social and mental health support for Black women. We investigated if this additional support led to increased blood pressure control, breast feeding initiation and continuation and increased postpartum mental health/social support.  

Key Findings, Main Impacts 

Observed daily rates of blood pressure monitoring and submission to the STAC program, while not as high as hoped, did show an increase with doula support. There was a 10% increase in breastfeeding rates at 6-weeks postpartum compared to hospital discharge. No participants engaged with mental health support when offered. These findings support the healthcare team partnering with community engagement to reduce the increasing rates of perinatal morbidity and mortality among Black women in the US.  

Publications

This work was supported by two sources: K Hoppe Obgyn Start-Up—UWF—SMPH Research and Development (AAB8581) and K Hoppe Staying Healthy After Childbirth: A Program to help new moms with high blood pressure—UWF—Wisconsin Partnership—MERC (AAH7613). 

This was a large multi-site trial that took place in two midwestern teaching academic hospitals to evaluate the impact of telephone health coaching  and blood pressure self-monitoring on systolic and diastolic blood pressure and health behaviors at 6 and 12 months.  

Key Findings, Main Impacts 

The MyHEART intervention did not demonstrate a significant change in systolic or diastolic blood pressure at 6 or 12 months between study groups, however, Intervention participants had a significant reduction in dietary sodium intake, increased physical activity, and increased home blood pressure monitoring compared with control participants. These findings suggest that the MyHEART intervention could support behavioral changes in young adults with uncontrolled hypertension. 

Publications 

• Effect of a Telephone Health Coaching Intervention on Hypertension Control in Young Adults - JAMA Network Open
• Concepts from behavioral theories can guide clinicians in coaching for behavior change - Patient Education and Counseling
• Guideline-directed antihypertensive medication use among young adult participants with uncontrolled hypertension at enrollment in the MyHEART study - BMC Cardiovascular Disorders

Research Summary

Clinical Problem

More than 10 million individuals aged 18 to 39 years (1 in 5 men; 1 in 6 women) have hypertension, which increases the risk of premature heart failure, stroke, and chronic kidney disease. Less than 50% of young adults have achieved blood pressure (BP) control.

Clinical Trial

DESIGN: This randomized clinical trial included male and female participants aged 18 to 39 years with uncontrolled hypertension confirmed by 24-hour ambulatory blood pressure (AMBP) testing from October 2017 to February 2022.

INTERVENTION: The My Hypertension Education and Reaching Target (MyHEART) intervention consisted of telephone health coaching every 2 weeks for 6 months, with home blood pressure monitoring. Control patients received routine hypertension care.

Results

There was no significant difference between control and intervention groups for 24-hour AMBP nor clinic systolic or diastolic blood pressure at 6 or 12 months. Both groups showed a reduction in blood pressure.

The MyHEART intervention did result in positive behavior changes for BP management.

Conclusions

• The MyHEART intervention did not demonstrate a significant change in systolic or diastolic blood pressures at 6 or 12 months between study groups.
• However, both study groups had an appreciable reduction in blood pressure.
• Intervention participants had a significant reduction in dietary sodium intake, increased physical activity, and increased home blood pressure monitoring compared with control participants.

These findings suggest that the MyHEART intervention could support behavioral changes in young adults with uncontrolled hypertension.

Funding/Support: This work was funded by grant R01HL132148 from the National Heart, Lung, and Blood Institute. 

View research summary as a PDF here. 

This was a large multi-site trial conducted across the US to assess the benefits and safety of the treatment of mild chronic hypertension (blood pressure <160/100 mm Hg) in pregnancy. 

Key Findings

In pregnant women with mild chronic HTN, treating BP to <140/90 mm Hg was associated with better pregnancy outcomes that the strategy of reserving treatment for only severe HTN, with no increased risk of small for gestational age birth weight for the baby.  

Learn more about the CHAP trial and findings in this research summary (PDF). 

Publications

Treatment for Mild Chronic Hypertension During Pregnancy - New England Journal of Medicine

Clinical Trials That Have Changed Obstetric Practice: The Chronic Hypertension and Pregnancy (CHAP) Trial - Clinical Obstetrics and Gynecology

Funding/support: This work was funded by grant U01 HL120338/HL/NHLBI NIH HHS/United States from the National Heart, Lung, and Blood Institute.