Community Health Worker Support to Lower Blood Pressure After a Pregnancy With High Blood Pressure

This is a single-site, two-arm, parallel, randomized controlled efficacy trial conducted at the University of Alabama at Birmingham (UAB), building on the AW2H feasibility/acceptability pilot (NCT06353256, N=61). Postpartum patients with pregnancy-associated hypertension (gestational hypertension, preeclampsia, eclampsia, hypertension with superimposed preeclampsia, or HELLP syndrome) or stage 2 hypertension (SBP >=140 mmHg or DBP >=90 mmHg) are randomized 1:1 to usual care or usual care plus a 6-month CHW intervention delivered in partnership with ConnectionHealth.

Usual care (both arms) includes brief self-measured blood pressure education, a pregnancy-validated iHealth BP Cuff Kit (provided through partnership with the Preeclampsia Foundation), and written education on hypertensive disorders of pregnancy and long-term cardiovascular risk. The CHW intervention adds visits or contacts approximately 2 times per week for weeks 1-5, weekly for weeks 6-12, and monthly for weeks 13-26 (in person or virtual), covering home BP monitoring coaching with ACOG-concordant escalation guidance, medication adherence, postpartum and pediatric visit reminders, breastfeeding and contraception counseling, Life's Essential 8 behavior coaching, primary care linkage, mother-baby education, and trauma-informed emotional support.

The primary outcome is mean systolic blood pressure at 6 months post-enrollment (mean of 3 readings taken 1 minute apart with the validated iHealth monitor, following a protocol adapted from the CHAP Maternal Follow-up Study). The trial provides 80% power to detect a 7 mmHg difference in SBP (SD 14.5, two-sided alpha=0.05) with 138 participants; enrollment of 174 allows for 20% attrition. Analysis follows intent-to-treat principles. Aim 2 comprises qualitative interviews (up to 20 intervention-arm participants) and two focus groups (CHWs/ConnectionHealth leadership; healthcare providers) analyzed thematically to inform future implementation.

Inclusion criteria

• Postpartum patients with pregnancy-associated hypertension (gestational hypertension, preeclampsia, eclampsia, hypertension with superimposed preeclampsia, or HELLP syndrome) or stage 2 hypertension per ACC/AHA guidelines (SBP >=140 mmHg or DBP >=90 mmHg) on two separate occasions at delivery-related hospital discharge or during the postpartum period
• Delivered in the last six weeks at >=14 weeks gestational age, including pregnancy loss
• 16-56 years old
• Speaks and writes in English
• Delivering at UAB Hospital

Exclusion criteria

• Declines randomization
• Does not speak English
• Currently incarcerated
• Currently enrolled in other community health worker studies or services