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Optimizing treatment of chronic hypertension in pregnancy using a national distributed data network

Award Number: K01HL171699
ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: TRAINING/TRAINEESHIP
PERIOD OF PERFORMANCE START DATE: 12/14/2023
PERIOD OF PERFORMANCE END DATE: 11/30/2028

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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.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $171,396 )
2025	2025	THE LELAND STANFORD JUNIOR UNIVERSITY	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Cardiovascular Diseases Research	000	2	11/27/2024	NON-COMPETING CONTINUATION	$171,396
														Subtotal = $171,396

Issue Date FY: 2024 ( Subtotal = $171,396 )
2024	2024	THE LELAND STANFORD JUNIOR UNIVERSITY	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Cardiovascular Diseases Research	000	1	12/14/2023	NEW	$171,396
														Subtotal = $171,396

Grand Total All Awards = $342,792

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Optimizing treatment of chronic hypertension in pregnancy using a national distributed data network

Award Number: K01HL171699

ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: TRAINING/TRAINEESHIP

PERIOD OF PERFORMANCE START DATE: 12/14/2023

PERIOD OF PERFORMANCE END DATE: 11/30/2028

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