REACH BP: REmote physical ACtivity intervention for High Blood Pressure Postpartum - Hypertension (HTN) is a major and growing public health problem. It is one of the most important modifiable risk factors for cardiovascular disease (CVD) and affects >30 million young adults. Among women, blood pressure (BP) elevations are common during pregnancy and the first year postpartum. Even in the absence of a hypertensive disorder of pregnancy, subclinical BP elevations (120-139/80-89) during pregnancy are associated with substantially higher risk of postpartum progression to Stage 2 HTN requiring pharmacotherapy, as well as long-term risk of CVD. Lifestyle change, such as increasing physical activity, is the primary guideline recommended strategy to target BP lowering for young adults. However, physical activity commonly declines throughout pregnancy and the early postpartum period. Novel strategies that can be widely disseminated are critically needed to improve physical activity and prevent HTN progression in this critical first year postpartum. Therefore, in this K23 proposal, Dr. Natalie Cameron aims to develop and pilot an electronic health record (EHR)-based physical activity intervention to prevent postpartum HTN progression among women with subclinical BP elevations during pregnancy. Specific aims are to (1) identify factors that influence postpartum physical activity and motivate women to engage in physical activity to lower blood pressure, (2) develop and refine intervention messaging, and (3) test the feasibility and acceptability of the intervention in a pilot randomized controlled trial. To accomplish the specific aims, Dr. Cameron and her mentorship team have created a comprehensive training plan consisting of formal coursework, conferences, structured mentorship and experiential learning. This includes training in qualitative research, intervention development, recruitment and retention postpartum, grantsmanship and leadership. Dr. Cameron will have robust support from the Division of General Internal Medicine and Department of Preventive Medicine, as well as an unparalleled team of mentors, who have expertise in postpartum interventions, EHR-based clinical trials, HTN and qualitative research. This K23 award will support Dr. Cameron’s successful transition to independence and her long-term goal to be an independently funded clinician-scientist who designs and conducts effectiveness trials to prevent and treat HTN postpartum. The proposed research aligns with federal funding priorities to prevent and reverse chronic disease through lifestyle changes. Furthermore, it promotes the NHLBI’s strategic vision to optimize and implement research that improves health using novel platforms that link EHRs to personal health data, thus creating an interface between clinical research and practice.
