Optimizing treatment of chronic hypertension in pregnancy using a national distributed data network - PROJECT SUMMARY/ABSTRACT Chronic hypertension in pregnancy is a growing contributor to adverse obstetrical and neonatal outcomes, but treatment with antihypertensives has been controversial due to unclear potential benefits and harms. However, in 2022, a large randomized controlled trial reported benefits of treating chronic hypertension in pregnancy to achieve blood pressure targets that are recommended for nonpregnant people (<140/90 mm Hg) without increasing risk to the fetus. Shortly thereafter, leading obstetrical societies in the U.S. issued recommendations to align with the trial findings. The long-term goal of the proposed project is to generate knowledge that improves the quality and equity of clinical care for pregnant and postpartum people with cardiovascular disorders and ultimately prevent morbidity and mortality. The overall objective is to leverage a nationwide distributed data network of electronic health records and administrative claims to inform optimal therapy for chronic hypertension in pregnancy. The central hypothesis is that type of medication, initiation timing, dose, and adherence affect outcomes of chronic hypertension treatment in pregnancy, which further differs with concomitant comorbidities. The rationale for this project is that recently revised national recommendations will likely increase the use of antihypertensive therapy for chronic hypertension in pregnancy, and the findings from this study will provide critical evidence on optimal therapy. The central hypothesis will be tested through three specific aims: 1) Compare the overall effectiveness and safety of the most commonly used medications to treat chronic hypertension in pregnancy; 2) Assess the impact of timing of initiation, dose, and adherence on the benefits and safety of treating chronic hypertension in pregnancy; and 3) Evaluate the benefits and safety of treating chronic hypertension in people with concomitant comorbidities, including multifetal gestation, severe obesity, preexisting diabetes mellitus, and chronic kidney disease. The proposed project is innovative by applying a target trial framework and advanced causal inference methods in a distributed data network created by the candidate. The research project is significant because optimizing treatment of chronic hypertension in pregnancy has the potential to benefit both the short- and long-term health of many pregnant people and their infants. This work will also be critically informative for future research led by the candidate on improving the treatment of preeclampsia, and hypertensive disorders during both the antepartum and postpartum periods. The proposed research and training will be accomplished with an exceptional mentorship team at Stanford University. The candidate will build on a strong background in perinatal epidemiology to gain expertise in perinatal pharmacoepidemiology, medical informatics and hypertensive disorders in pregnancy and postpartum. Together, the research and training will advance the candidate’s goal of leading an independent research program that improves the cardiovascular health of pregnant and postpartum people.
