PIVOT-HDP - A pragmatic hybrid implementation-effectiveness randomised study to transform postpartum cardiovascular and kidney health after pregnancies complicated by hypertension.

Hypertensive disorders of pregnancy (HDP) complicate ~10% of pregnancies. HDP is a well-recognised contributor to future cardiometabolic, cerebrovascular, and kidney disease. The first postpartum year represents a critical period for blood pressure optimisation to prevent abnormal cardiac remodelling, chronic hypertension, and the adverse changes to long-term heart, kidney, and brain health. The importance of postpartum care following HDP is highlighted in national and international best practice guidelines. However, postpartum follow-up in Australia is fragmented and inconsistent, with few receiving recommended care. As such, a significant evidence-to-practice gap exists, with postpartum people missing out on critical opportunities for disease prevention and risk management.

PIVOT-HDP will address this gap by evaluating the use of a technology-enabled postpartum care pathway to capture this critical healthcare period. We will conduct a pragmatic hybrid implementation-effectiveness randomised study to evaluate whether self-monitored blood pressure, at-home antihypertensive titration, and digitally coordinated clinical management can improve engagement with follow-up, blood pressure control, cardiovascular, brain, and kidney outcomes. Sustained implementation will be informed through also determining the program’s feasibility, acceptability, cost-effectiveness, and scalability to a diverse population of women attending Victoria’s largest maternity service.

Through offering a comprehensive, accessible, and safe alternative to traditional fragmented postpartum care, this work seeks to improve follow-up rates, strengthen early risk identification and management, and optimise women’s long-term health trajectories. This work directly addresses the stark discrepancy between best practice guidelines and current care in Australia. It also has the potential to inform and redefine global recommendations for postpartum cardiometabolic, kidney, and neurological risk management.