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

NCT ID: NCT06220721

Last Updated: 2025-05-11

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

618 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-10-23

Study Completion Date

2029-06-30

Brief Summary

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The long-term goal of our work is to evaluate the effect of intensive postpartum blood pressure control on maternal cardiovascular health, risk of chronic hypertension, and reversal of vascular dysfunction generated by hypertensive disorders of pregnancy, thus attenuating the lifelong trajectory of cardiovascular disease risk.

Detailed Description

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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.

Conditions

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Hypertension, Pregnancy-Induced

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Parallel Assignment
Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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REPAIR ARM

Intensive postpartum blood pressure control with nifedipine ER initiation at systolic blood pressure (SBP) ≥140 mmHg or diastolic blood pressure (DBP) ≥90 mmHg and maintaining blood pressure \<140/90 mmHg during the first 6 weeks postpartum.

Group Type EXPERIMENTAL

Nifedipine ER

Intervention Type DRUG

Initiation of nifedipine ER postpartum at randomly assigned threshold during the first 6 weeks postpartum.

CONTROL ARM

Usual care with nifedipine ER initiation at SBP ≥150 mmHg or DBP ≥100 mmHg and maintaining blood pressure \<150/100 mmHg during the first 6 weeks postpartum.

Group Type ACTIVE_COMPARATOR

Nifedipine ER

Intervention Type DRUG

Initiation of nifedipine ER postpartum at randomly assigned threshold during the first 6 weeks postpartum.

Interventions

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Nifedipine ER

Initiation of nifedipine ER postpartum at randomly assigned threshold during the first 6 weeks postpartum.

Intervention Type DRUG

Other Intervention Names

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Procardia XL Adalat XL

Eligibility Criteria

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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
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

NIH

Sponsor Role collaborator

Medical College of Wisconsin

OTHER

Sponsor Role lead

Responsible Party

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Anna Palatnik, MD

Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Anna Palatnik, MD

Role: PRINCIPAL_INVESTIGATOR

Medical College of Wisconsin

Locations

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Northwestern University

Chicago, Illinois, United States

Site Status RECRUITING

Medical College of Wisconsin

Milwaukee, Wisconsin, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Alyssa M Hernandez, DO

Role: CONTACT

4148055285

Amandla Stanley, MSN

Role: CONTACT

4148056691

Facility Contacts

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Lynn Yee, MD

Role: primary

Alyssa M Hernandez, DO

Role: primary

4148055285

Amandla Stanley, MSN

Role: backup

4148056691

References

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Duffy JMN, Cairns AE, Magee LA, von Dadelszen P, van 't Hooft J, Gale C, Brown M, Chappell LC, Grobman WA, Fitzpatrick R, Karumanchi SA, Lucas DN, Mol B, Stark M, Thangaratinam S, Wilson MJ, Williamson PR, Ziebland S, McManus RJ; International Collaboration to Harmonise Outcomes for Pre-eclampsia (iHOPE). Standardising definitions for the pre-eclampsia core outcome set: A consensus development study. Pregnancy Hypertens. 2020 Jul;21:208-217. doi: 10.1016/j.preghy.2020.06.005. Epub 2020 Jun 20.

Reference Type BACKGROUND
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Reference Type BACKGROUND
PMID: 33345653 (View on PubMed)

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Reference Type BACKGROUND
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Reference Type BACKGROUND
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Reference Type BACKGROUND
PMID: 26711737 (View on PubMed)

Hirshberg A, Downes K, Srinivas S. Comparing standard office-based follow-up with text-based remote monitoring in the management of postpartum hypertension: a randomised clinical trial. BMJ Qual Saf. 2018 Nov;27(11):871-877. doi: 10.1136/bmjqs-2018-007837. Epub 2018 Apr 27.

Reference Type BACKGROUND
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Lopes Perdigao J, Hirshberg A, Koelper N, Srinivas SK, Sammel MD, Levine LD. Postpartum blood pressure trends are impacted by race and BMI. Pregnancy Hypertens. 2020 Apr;20:14-18. doi: 10.1016/j.preghy.2020.02.006. Epub 2020 Feb 26.

Reference Type BACKGROUND
PMID: 32143061 (View on PubMed)

Stuart JJ, Tanz LJ, Rimm EB, Spiegelman D, Missmer SA, Mukamal KJ, Rexrode KM, Rich-Edwards JW. Cardiovascular Risk Factors Mediate the Long-Term Maternal Risk Associated With Hypertensive Disorders of Pregnancy. J Am Coll Cardiol. 2022 May 17;79(19):1901-1913. doi: 10.1016/j.jacc.2022.03.335.

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Reference Type BACKGROUND
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Other Identifiers

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1R01HD112930-01A1

Identifier Type: NIH

Identifier Source: secondary_id

View Link

PRO00049909

Identifier Type: -

Identifier Source: org_study_id

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