Reducing the Risk of Chronic Hypertension and Improving Vascular Function Following Preeclampsia

The REPAIR trial is a multicenter randomized controlled trial of 618 postpartum patients with hypertensive disorders of pregnancy randomized to intensive blood pressure control versus usual care during the first 6 weeks postpartum. The intervention group will receive intensive blood pressure (BP) control with nifedipine extended-release initiation when BP is ≥ 140/90 mmHg. The active control group will receive usual care with nifedipine ER initiation when BP is ≥ 150/100. The study will take place at two clinical sites: Medical College of Wisconsin (MCW) and Northwestern University (NU). All participants will undergo BP monitoring, cardiovascular function assessment, and collection of cardiovascular biomarkers at baseline, 6 weeks, and 12 months postpartum. Specifically, cardiac function and structure will be assessed with transthoracic echocardiogram, endothelial dysfunction with brachial artery flow-mediated dilation, and arterial stiffness with carotid-femoral pulse wave velocity. The primary outcome is the incident diagnosis of stage I hypertension at one year postpartum.

Inclusion criteria

• Hypertensive disorders of pregnancy (HDP) diagnosis, specifically gestational hypertension, preeclampsia, eclampsia, or HELLP syndrome, according to ACOG guidelines
• Postpartum day 0-4
• Age ≥ 18 years
• Able to communicate in English or in Spanish
• Has an established OBGYN at an MCW or NU health system practice that has access to Epic electronic medical records.

Exclusion criteria

• Pre-gestational hypertension
• Type 1 or type 2 diabetes mellitus
• Admitted to intensive care unit at the time of screening
• Diagnosed with HDP during postpartum readmission after discharge from delivery hospitalization
• Getting discharged on the day of screening
• Known allergy or contraindication to nifedipine ER
• Inability or unwillingness to provide informed consent
• Already taking long-acting antihypertensive medication for standard care
• Maternal conditions that impact study outcomes: sickle cell disease, systemic lupus erythematosus