Blood Pressure Measurement and Hypertension in Pregnancy

项目总结/摘要 博士娜塔莉·A贝洛是一名心脏病专家，其长期职业目标是产生和传播经验性的 降低高血压疾病导致的母胎发病率和死亡率负担的证据 妊娠（HDP）她寻求K23职业发展奖来实现这一目标，并组建了一个 高血压（HTN）高级研究者的多学科团队（Daichi Shimbo和Suzanne Oparil博士）， 门诊外血压（BP）测量，包括家庭BP监测（HBPM）（Shimbo博士和 约瑟夫·施瓦茨）、流行病学（保罗·蒙特纳博士）、母胎医学（艾伦·蒂塔和罗纳德博士 Wapner）和生物统计学（Schwartz和Muntner博士）。贝洛博士的培训将包括四个模块：（1） 妊娠期高血压疾病，（2）HTN诊断和治疗的研究方面，（3） HTN的高级研究设计和统计分析，以及（4）研究传播和过渡到 独立HDP，包括慢性和妊娠期HTN，与实质性母胎妊娠相关。 发病率和死亡率。慢性妊娠合并高血压综合征孕妇血压的准确测定 HTN是必不可少的，因为HTN的治疗不足和过度可能会对母亲和/或胎儿造成伤害。 传统的诊所BP（CBP），涉及医疗保健提供者测量BP，是一个贫穷的替代品， 自然环境中的生态BP。与CBP相比，HBPM上的门诊BP更好地估计 生态BP，因此可能是胎盘灌注的上级测量。尽管这些数据表明， HBPM在慢性和妊娠期HTN的管理中具有重要作用， 限制HBPM在该人群中广泛使用的差距。HBPM的最低天数， 可靠地估计平均家庭BP，以及妊娠期长期坚持HBPM的妇女， 慢性和妊娠HTN尚不清楚。最后，对未怀孕个体的研究表明， 传统CBP，在没有医疗保健提供者的情况下使用自动设备测量CBP （无人值守CBP）可能更接近门诊外BP。在拟议项目中， 需要HBPM天来提供平均家庭BP的可靠估计（主要目标1）和长期 将确定妊娠期间对HBPM的依从性（主要目的2）。是否意味着无人值守CBP 与传统CBP相比，更接近平均家庭BP（次要目的）。主要目标1和 次要目的将在105名患有慢性和慢性乙型肝炎的孕妇（妊娠<34周）中进行。 妊娠HTN将接受HBPM 14天，采用传统和无人值守的CBP测量（研究 1）。主要目标2将在75名患有慢性和妊娠HTN的孕妇中进行， 从孕中期（妊娠第20-26周）到分娩，每天进行HBPM（研究2）。这些 这些数据将为贝洛博士的HDP研究计划提供信息，并为她设计更大的 基于结果的研究（R 01）检查HBPM和CBP在妊娠中的作用。 1

PROJECT SUMMARY/ABSTRACT Dr. Natalie A. Bello is a cardiologist whose long-term career goal is to generate and disseminate empiric evidence to reduce the burden of maternal-fetal morbidity and mortality resulting from hypertensive disorders of pregnancy (HDP). She seeks a K23 Career Development Award to attain this goal, and has assembled a multidisciplinary team of senior investigators in hypertension (HTN) (Drs. Daichi Shimbo and Suzanne Oparil), out-of-clinic blood pressure (BP) measurement including home BP monitoring (HBPM) (Drs. Shimbo and Joseph Schwartz), epidemiology (Dr. Paul Muntner), maternal-fetal medicine (Drs. Alan Tita and Ronald Wapner), and biostatistics (Drs. Schwartz and Muntner). Dr. Bello’s training will consist of four modules: (1) Hypertensive Disorders of Pregnancy, (2) Research Aspects of the Diagnosis and Treatment of HTN, (3) Advanced Study Design and Statistical Analysis in HTN, and (4) Research Dissemination and Transition to Independence. HDP, including chronic and gestational HTN, are associated with substantial maternal-fetal morbidity and mortality. The accurate determination of BP in pregnant women with chronic and gestational HTN is essential, as both under- and over-treatment of HTN may result in harm to the mother and/or fetus. Traditional clinic BP (CBP), which involves a healthcare provider measuring BP, is a poor surrogate for ecological BP in the naturalistic environment. Compared to CBP, out-of-clinic BP on HBPM better estimates ecological BP, and thus may be a superior measure of placental perfusion. Although these data suggest that HBPM has an essential role in the management of chronic and gestational HTN, there are several knowledge gaps that limit the widespread use of HBPM in this population. The minimum number of days of HBPM to reliably estimate mean home BP, and the long-term adherence to HBPM during pregnancy among women with chronic and gestational HTN are unknown. Finally, studies of non-pregnant individuals show that compared to traditional CBP, CBP measured using an automated device in the absence of a healthcare provider (unattended CBP) may better approximate out-of-clinic BP. In the proposed project, the minimum number of days of HBPM needed to provide a reliable estimate of mean home BP (Primary Aim 1) and the long-term adherence to HBPM during pregnancy (Primary Aim 2) will be determined. Whether mean unattended CBP versus traditional CBP is closer to mean home BP (Secondary Aim) will also be assessed. Primary Aim 1 and Secondary Aim will be addressed among 105 pregnant women (<34 weeks gestation) with chronic and gestational HTN who will undergo HBPM for 14 days with traditional and unattended CBP measurement (Study 1). Primary Aim 2 will be addressed among 75 pregnant women with chronic and gestational HTN who will undergo HBPM daily from the second trimester (gestational week 20-26) through delivery (Study 2). These data will inform Dr. Bello’s program of research on HDP, and will provide the foundation for her to design larger outcomes-based studies (R01) examining the role of HBPM and CBP in pregnancy. 1