Hypertension in Pregnancy Action Forum

Hypertension in pregnancy (i.e. chronic hypertension, gestational hypertension, preeclampsia, eclampsia, and chronic hypertension with superimposed preeclampsia or eclampsia) is associated with adverse pregnancy outcomes and serious maternal complications such as myocardial infarction, stroke, cardiomyopathy, seizures, and death.^1-5 Hypertension in pregnancy is also associated with the long-term risk of developing hypertension and cardiovascular disease for both women and their children.^{1, 6-9}

Million Hearts^® Hypertension in Pregnancy Action Forum (HPAF) is a national collaborative for clinical, public health, and community-based partners to exchange best and promising practices, identify solutions to common obstacles, and share resources related to improving hypertension management for women during and after pregnancy.

Previous Forums

This meeting introduced the HPAF and provided an overview of the Hypertension in Pregnancy Change Package. You can view the recording here.

Supporting Changes to Care Processes: Million Hearts^® Hypertension in Pregnancy Change Package – Hilary K. Wall, MPH

This meeting provided strategies from the Hypertension in Pregnancy Change Package to improve aspirin prophylaxis for preeclampsia prevention and provided an overview of a quality improvement intervention that improved aspirin prescribing among patients at risk for preeclampsia. You can view the recording here.

Pathways to Improve Aspirin Prophylaxis from the Hypertension in Pregnancy Change Package – Hilary K. Wall, MPH

Missed Opportunities in Aspirin Prescribing for Preeclampsia: Interventions and Next Steps –Aimee Smith, DO; Noreen Singh, MD; Saskia Shuman, MPH

Tools and Resources

For Clinicians

Hypertension in Pregnancy Change Package (HPCP)
The HPCP is a quality improvement tool to help outpatient clinicians put more efficient and effective systems in place to care for patients with hypertension in pregnancy.
Postpartum Hypertension Clinic Development Toolkit
This toolkit from the American College of Cardiology helps clinicians, health care teams, and health systems develop postpartum hypertension care programs for individuals with a recent hypertensive disorder of pregnancy.
Chronic Hypertension and Pregnancy (CHAP) Trial Consortium. Treatment for Mild Chronic Hypertension during Pregnancy
This randomized trial found a strategy of targeting a blood pressure of less than 140/90 mm Hg was associated with better pregnancy outcomes than a strategy of reserving treatment only for severe hypertension.
ACOG Practice Advisory: Clinical Guidance for the Integration of the Findings of the Chronic Hypertension and Pregnancy (CHAP) Study
This practice advisory from the American College of Obstetricians and Gynecologists recommends utilizing 140/90 mm Hg as the threshold for initiation or titration of medical therapy for chronic hypertension in pregnancy, rather than the previously recommended threshold of 160/110 mm Hg.
Society for Maternal-Fetal Medicine Statement: Antihypertensive therapy for mild chronic hypertension in pregnancy-The Chronic Hypertension and Pregnancy trial
This statement from the Society for Maternal-Fetal Medicine recommends treatment with antihypertensive therapy for mild chronic hypertension in pregnancy to a goal BP of <140/90 mm Hg.

Garovic VD, Dechend R, Easterling T, Karumanchi SA, McMurtry Baird S, Magee LA, et al. Hypertension in pregnancy: diagnosis, blood pressure goals, and pharmacotherapy: a scientific statement from the American Heart Association [published correction appears in Hypertension. 2022 Mar;79(3):e70]. Hypertension. 2022;79(2):e21–e41.
Wu DD, Gao L, Huang O, Ullah K, Guo M-X, Liu Y, et al. Increased adverse pregnancy outcomes associated with stage 1 hypertension in a low-risk cohort: evidence from 47,874 cases. Hypertension. 2020;75(3):772–780.
Bramham K, Parnell B, Nelson-Piercy C, Seed PT, Poston L, Chappell LC. Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis. BMJ. 2014;348:g2301.
Li F, Wang T, Chen L, Zhang S, Chen L, Qin J. Adverse pregnancy outcomes among mothers with hypertensive disorders in pregnancy: a meta-analysis of cohort studies. Pregnancy Hypertens. 2021;24:107–117.
Murray Horwitz ME, Rodriguez MI, Dissanayake M, Carmichael SL, Snowden JM. Postpartum health risks among women with hypertensive disorders of pregnancy, California 2008–2012. J Hypertens. 2021;39(5):1009–1017.
Wu P, Chew-Graham CA, Maas AH, Chappell LC, Potts JE, Gulati M, et al. Temporal changes in hypertensive disorders of pregnancy and impact on cardiovascular and obstetric outcomes. Am J Cardiol. 2020;125(10):1508–1516.
Nahum Sacks K, Friger M, Shoham-Vardi I, Spiegel E, Sergienko R, Landau D, Sheiner E. Prenatal exposure to preeclampsia as an independent risk factor for long-term cardiovascular morbidity of the offspring. Pregnancy Hypertens. 2018;13:181–186.
Kajantie E, Eriksson JG, Osmond C, Thornburg K, Barker DJP. Preeclampsia is associated with increased risk of stroke in the adult offspring: the Helsinki Birth Cohort Study. Stroke. 2009;40(4):1176–1180.
Andraweera PH, Lassi ZS. Cardiovascular risk factors in offspring of preeclamptic pregnancies: Systematic review and metaanalysis. J Pediatr. 2019;208:104–113.e6.