CDC change package offers menu of strategies to prevent, manage hypertension in pregnancy

Key takeaways:

• A CDC Million Hearts change package includes evidence- or practice-based tools for preventing and managing gestational hypertension.
• The strategies are designed for use across medical specialties.

SAN FRANCISCO — Effective strategies to prevent and manage hypertensive disorders of pregnancy are often underutilized, but a new CDC initiative aims to harness solutions that work and package them in one place for busy clinicians.

The CDC's National Center for Chronic Disease Prevention and Health Promotion released a Hypertension in Pregnancy Change Package, developed in partnership with ACOG and other leading authorities in maternal health, which serves as an evidence-informed listing of process improvements with accompanying tools and resources for clinicians caring for pregnant and postpartum women.

The focus of the change package is early identification, optimal management and prevention of complications of hypertension in pregnancy.

“Hypertension of any type during pregnancy marks a women for having elevated risk for heart disease and stroke,” Janet S. Wright, MD, MACC, FPCNA, director of the division for heart disease and stroke prevention and the National Center for Chronic Disease Prevention and Health Promotion at the CDC, said during a press conference at the ACOG Annual Clinical & Scientific Meeting. “Forty percent to 50% of women with hypertension during pregnancy are hypertensive at 6 weeks [after delivery]; about 40% with severe preeclampsia are hypertensive at 1 year. You get stuck with this tattoo.”

Janet S. Wright

As Healio previously reported, hypertensive disorders of pregnancy are the second leading cause of maternal death behind maternal hemorrhage and are a significant cause of short- and long-term maternal and offspring morbidity worldwide. Prior research indicates hypertension develops faster among women who experienced hypertensive disorders of pregnancy, up to 10 years earlier, compared with women with normotensive pregnancies.

For pregnant and postpartum women, poorly controlled hypertension can have serious implications, including markedly increased risk for stroke, Wright said. Despite the risks, hypertension prevalence is likely underestimated; measurements are often done incorrectly and clinical inertia contributes to poor BP control.

“Overall, we know that because of this epidemic of hypertension, more women are going into pregnancy with hypertension, often undetected,” Wright said. “If detected, it is often uncontrolled. It is a systems issue and it needs a systems solution.”

Strategies to support healthy pregnancies

To assist health care professionals, CDC’s Million Hearts initiative, in collaboration with experts in women’s, maternal, and fetal health and hypertension, developed the Hypertension in Pregnancy Change Package. The guide, which Wright described as a “menu” of more than 350 proven strategies from collaborators all over the United States, contains tools to help busy outpatient clinical teams effectively detect and manage hypertension both during and after pregnancy.

The guide includes strategies to support home-monitored or out-of-office BP; aspirin use to prevent preeclampsia; recommendations for a healthy lifestyle; and the use of anti-hypertensive medications that are safe and effective during pregnancy and lactation. The change package also includes information on how to help patients access antihypertensive medications specifically recommended for pregnant women, which may not always be the lowest priced options or the options covered by health plans, Wright said.

“Knowing is not doing,” Wright said. “This package was envisioned as a tool to help busy outpatient clinical teams turn ‘what works’ into ‘what happens’ in their practice. This is for people across the spectrum — primary care, OB/GYN, cardiology. Getting focused on the latest evidence and what the strategies are will have the greatest return.”

Use tailored interventions

Wright cautioned that hypertensive disorders of pregnancy do not affect all women equally. Black and Indigenous women have higher rates of elevated BP and lower rates of hypertension control, as do women living in the South, Midwest or in more rural parts of the U.S. These populations require tailored interventions, which are also addressed in the package.

The change package is broken down into four focus areas:

• Key foundations
• Equipping care teams
• Population health management
• Individual patient supports

“What makes me optimistic about this is never have we lived in a time where the evidence is more solid about what to do,” Wright said. “There is also a lot of attention on women’s health, maternal health and making the connection to hypertension.

“What I hope is that people get a sense of, ‘this is doable,’” Wright said. “[The package has] bite size pieces and bigger pieces. We do not presume to know the best fit for a practice. There are resources from places that have used these tools.”

Wright stressed that any strategies outlined in the package should first be tested on a small scale — conducting “small tests of change” — to assess feasibility and allow the team to evaluate and adjust before instituting the change on a broader, more permanent scale. The CDC does not recommend that any practice attempt to implement all of the interventions at once, nor is it likely that all interventions will be applicable to all clinical settings.

Wright said ongoing issues continue to need attention, including more resources to address gaps in care for women with hypertension during the first year after delivery.

“The ability to conduct timely detection and management of hypertension in pregnancy means we are investing in generational health,” Wright said. “It is not about managing that woman during pregnancy. It is about managing that woman for the rest of her life.”

Reference:

• Hypertension in Pregnancy Change Package. Available at: Hypertension in Pregnancy Change Package (hhs.gov). Accessed: May 17, 2024.