SNAP2 - Optimising the management of blood pressure following hypertensive pregnancy to reduce cardiovascular risk
To develop and test the clinical and cost-effectiveness of an intervention to support self-management of antihypertensive medication following a hypertensive pregnancy. The intervention aims to improve long-term BP control and therefore reduce adverse cardiovascular outcomes and the associated costs to the NHS.
WHY THIS IS IMPORTANT:
High blood pressure (hypertension) during and following pregnancy affects around 80,000 women each year and can lead to very serious problems for women such as pre-eclampsia or stroke. In the longer term, women who had high BP in pregnancy have an increased risk of heart attack and stroke and this seems to be linked to their blood pressure in the early weeks following birth. Preliminary work suggests that allowing women to measure their own BP and adjust their own medication in the first six months following birth leads to long term reductions in BP. These reductions last after medication is stopped, perhaps due to direct effects on the heart.
Pilot studies: SNAP-HT and POP-HT
We have carried out some pilot work and the work is now published - see publications on this page
- SNAP- HT
These pilot studies have informed the planning of a large-scale programme of work including a multi-centre randomised controlled trial.
Key Programme research questions
Work Stream 1: What is usual care following a hypertensive pregnancy, where does clinical responsibility lie and how could a self-management intervention best fit with current care pathways?
Work Stream 2: What is the optimal self-management intervention for postnatal hypertension?
Work Stream 3: How can health equity best be ensured in postnatal hypertension self-management?
Work Stream 4: Does BP self-management in women following a hypertensive pregnancy lead to lower diastolic BP after six months compared to usual care?
Work Stream 5: Is postnatal BP self-management a cost-effective use of health care resources?
The programme will utilise a range of methods culminating in a trial:
WS1 Online surveys plus one-to-one interviews and focus groups (women and clinicians).
WS2 Iterative intervention development with co-production and qualitative research.
WS3 Qualitative work specifically targeting women’s experiences of care transitions following hypertensive pregnancy, accessibility for all and health equity in practice.
WS4 Randomised Controlled Trial of BP self-management for women requiring postnatal antihypertensive treatment, with qualitative process evaluation (SNAP2).
WS5 Economic evaluation, including within-trial cost and outcomes evaluations and long-term economic modelling.
WS6 Integrated patient and public involvement accompanied by knowledge mobilisation with wider stakeholders from intervention conception to dissemination and commercialisation.
HOW THIS COULD BENEFIT PATIENTS:
This work has the potential for a substantial impact on long-term women’s health following hypertensive pregnancy, reducing cardiovascular risk for millions of women over a twenty-year period. If our preparatory work is confirmed in the proposed programme then a relatively simple short-term intervention could have profound implications.
Patient and public involvement
Our emphasis on PPI and health equity (including consideration of different socio-economic and ethnic groups) aims to ensure that any such gains are applicable across the population. Dissemination will be wide and broad, engaging with policymakers, industry and relevant patient groups.
We are working with The Motherhood Group, Action on Pre-eclampsia, Birth Companions, the Muslim Women’s Network, and collaborators who have lived experience of blood pressure problems in pregnancy, to ensure we engage with a diverse mix of women who are currently or recently pregnant and our research, the intervention and study materials are sensitive, suitable and fit with the attitudes and needs of women. This work will be central to our success.
To read more about research into cardiovascular health and pregnancy that’s taking place here in Oxford see the Cardiovascular Disease & Pregnancy Research Collaborative pages
THE NEXT STEPS:
This programme of work will start on 1st July 2022.
Department Team Members
Length of project: 5 years
NIHR Collaboration for Leadership in Applied Health Research and Care Oxford.
NIHR Project reference: NIHR203283
- Professor Lucy Chappell FMedSci is the Chief Scientific Adviser for the Department of Health and Social Care (DHSC)
- Professor Paul Leeson Cardiovascular Clinical Research Facility, University of Oxford
- Dr Jamie Kitt
- Sandra Igwe
- Cynthia Ochieng
- Cristian Roman