(1075) Closing the evidence-to-practice gap: Evaluating implementation of the CHAP trial

The Chronic Hypertension and Pregnancy (CHAP) trial (Tita 2022) demonstrated improved pregnancy outcomes for patients with mild chronic hypertension (CHTN) when treating to a goal blood pressure (BP) ≤140/90, without impacting fetal growth. Here, we evaluate current adherence to this recommendation in order to identify levers for improved implementation.

Study Design:

We conducted a single-site, retrospective cohort study of patients with CHTN (≥2 BPs ≥140/90 at < 20 weeks gestation) who delivered at ≥20 weeks between 7/1/2023-12/31/2023. Baseline characteristics and prenatal BP management were analyzed using descriptive statistics. A “missed opportunity” for BP optimization per CHAP was defined as ≥2 BPs ≥140/90 at < 23 weeks gestation without medication initiation or uptitration. Patients with and without missed CHAP opportunities were compared using chi-square or Wilcoxon rank-sum as appropriate.

Results:

Among 134 included patients, mean maternal age was 34(+/-5) and median BMI was 37(IQR 32–43). 49% identified as White, 37% Black, 10% Latinx, and 2% as Asian. 25% began pregnancy on medication(s), and 35% of the cohort met criteria for a change in BP management per CHAP. When made, BP medication changes were most often made by a prenatal care provider (69%), followed by a maternal fetal medicine physician (25%). Changes occurred primarily at a prenatal care visit (69%), and secondarily on asynchronous chart review (9%) or an obstetric triage visit (6%). 17% of the overall cohort (n=23) had missed CHAP opportunities. These patients were more likely to receive care in a faculty practice (as compared to resident-run clinic), be nulliparous, and have been newly diagnosed with CHTN during pregnancy (Table).

Conclusion:

This study highlights opportunities for improved evidence-based BP management in pregnancy. Targeted interventions, such as electronic medical record alerts identifying eligible patients during prenatal care, may enhance adherence to guidelines, thereby improving pregnancy outcomes.