Around one in ten women develop high blood pressure during pregnancy, and half of them need medication to control it. After giving birth, these women face a doubled risk of later heart disease, yet their blood pressure management often falls through the cracks as they leave maternity care and focus on their new baby. This research aims to fix that gap. The team will develop and test a self-management intervention—essentially, giving women the tools and support to adjust their own blood pressure medication at home after a hypertensive pregnancy. They will first map current care, then co-design the intervention with patients and clinicians, and finally run a randomised controlled trial to see whether self-management leads to lower blood pressure after six months compared with usual care. A parallel economic evaluation will assess whether the approach saves the NHS money. If it works, a relatively simple, short-term change in postnatal care could reduce long-term cardiovascular risk for millions of women over the next two decades. The researchers are specifically designing the intervention to work across different ethnic and socioeconomic groups, so the benefits would not be limited to those who are white or better off.
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Background Hypertension in pregnancy affects around one in ten women, of whom approximately half need antihypertensive medication. Following birth, blood pressure (BP) at six weeks postnatal is related to long-term BP and women with pregnancy hypertension have a doubled risk of subsequent cardiovascular disease compared to normotensive women. Current postnatal hypertension management can be haphazard with short-term fluctuations in BP, a transition from maternity to primary care oversight, overstretched clinical services and women with priorities focussed on their new baby. Few data exist to guide improved care at this important time and these issues have only been compounded by the recent pandemic. Aims and objectives The overarching aim of this programme is to develop and test the clinical and cost-effectiveness of an intervention to support self-management of antihypertensive medication following a hypertensive pregnancy with the aim of improving long-term BP control and therefore reduce adverse cardiovascular outcomes and the associated costs to the NHS. Key research questions What is usual care following a hypertensive pregnancy, where does clinical responsibility lie and how could a self-management intervention best fit with current care pathways? (WS1) What is the optimal self-management intervention for postnatal hypertension? (WS2) How can health equity best be ensured in postnatal hypertension self-management? (WS3) Does BP self-management in women following a hypertensive pregnancy lead to lower diastolic BP after six months compared to usual care? (WS4) Is postnatal BP self-management a cost-effective use of health care resources? (WS5) These will be linked by patient and public involvement throughout and carefully disseminated including a comprehensive knowledge mobilisation process. Methods The programme will utilise a range of methods culminating in a trial: WS1 Online surveys plus one-to-one interviews and focus groups (women and clinicians) to understand usual postnatal hypertension care. WS2 Iterative self-management intervention development with co-production and qualitative research. WS3 Qualitative work specifically targeting women s experiences of care transitions following hypertensive pregnancy, accessibility for all and health equity in practice. WS4 Randomised Controlled Trial of BP self-management for women requiring postnatal antihypertensive treatment, with qualitative process evaluation (SNAP2). WS5 Economic evaluation including within-trial cost and outcomes evaluations and long-term economic modelling. WS6 Integrated patient and public involvement accompanied by knowledge mobilisation with wider stakeholders from intervention conception to dissemination and commercialisation. Timelines for delivery The programme will run for five years led by a programme management group overseen by a programme steering committee. Anticipated impact and dissemination This work has the potential for substantial impact on long term women s health following hypertensive pregnancy, reducing cardiovascular risk for millions of women over a twenty-year period. If our preparatory work is confirmed in the proposed programme then a relatively simple short-term intervention could have profound implications. Our emphasis on PPI and health equity (including consideration of different socio-economic and ethnic groups) aims to ensure that any such gains are applicable across the population and not simply for those of white ethnicity or higher socioeconomic status. Dissemination will be wide and broad, engaging with policy makers, industry and relevant patient groups.
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