Postpartum Home Visiting (HEART at Home)

High blood pressure during and after pregnancy can put people at risk for serious health problems after delivery. Many patients do not receive enough follow-up care once they leave the hospital, and high blood pressure can continue or worsen in the weeks after childbirth.

This study will test whether a new care approach is practical and acceptable for patients and health care teams. The study combines home blood pressure monitoring, home visits by trained postpartum doulas, and telehealth visits with medical providers during the first three months after delivery. This novel intervention is called HEART at Home (Home-based Engagement And Remote Treatment for Hypertension).

People who recently gave birth and have ongoing high blood pressure will be invited to join the study. Participants will measure their blood pressure at home using a provided cuff and share their readings through a secure mobile system. Nurses and doctors will review these readings and adjust blood pressure medications when needed. Participants will also receive home visits and phone or text check-ins from trained postpartum doulas, who will provide education, help with blood pressure measurement, and support in connecting to ongoing medical care. At about 12 weeks after delivery, participants will have planning for future care with a primary care provider or heart specialist.

The study will collect information about how easy the program is to carry out, how often participants complete visits, and how helpful participants and providers find the program. The study will also track blood pressure control and any emergency room visits or hospital readmissions related to blood pressure. This information will be used to improve postpartum care for people with high blood pressure in the future.

• HEART at Home (Behavioral): The intervention integrates biweekly home visitor-led BP monitoring and health education, extended rBPM through 12 weeks, protocol-driven escalation to the clinical team, and clinician-supervised medication management and telehealth follow-up. Core components of HEART at Home include: 1) home visiting-based BP measurement and support for patient-initiated rBPM between visits, 2) cardiovascular risk assessment and patient education, 3) protocolized clinical escalation and pharmacologic management, and 4) facilitated linkage to longitudinal clinical care.

Primary outcomes

• Adoption [continuous across 12 weeks]: Completion of >=1 home visit with blood pressure measurement and transmission to clinical team
• Reduction in Systolic BP [6 and 12 weeks postpartum]: Reduction in Systolic BP

Secondary outcomes

• Reduction in Diastolic Blood Pressure [6 weeks and 12 weeks postpartum]: Reduction in Diastolic Blood Pressure
• Number of Blood-Pressure Lowering Medication Changes [Continuous, 2-12 weeks postpartum]: Any initiation, discontinuation, dose change, or change in antihypertensive medication during weeks 2-12 postpartum.
• Blood pressure Control [6 and 12 weeks postpartum]: Proportion of patients with BP <130/80 mm Hg
• Fidelity [continuous, 2-12 weeks postpartum]: Completion of three scheduled in-person home visits, participation in remote BP monitoring during the intervention period with appropriate escalation of abnormal BP or symptoms
• Reach [Baseline (3-5 days postpartum)]: Recruitment rate over study enrollment period
• Time-Based Cost [continuous, 2-12 weeks]: number of additional minutes needed to deliver HEART at Home components at each home visit

Other outcomes

• Number of unplanned care utilization events (ED visits or hospital readmissions) [continous, 0-12 weeks postpartum]: number of escalation events from abnormal blood pressures, symptoms or medication changes

Sex: Female, ages: 18 Years to any

Inclusion Criteria:

* • Age ≥18 years

  * Enrollment in the Barnes Jewish Hospital rBPM program; as per eligibility criteria above, patient has a physician-made diagnosis of HDP per American College of Obstetricians and gynecologists criteria
  * Measured at least 4 days of blood pressure during initial program
  * At least one blood pressure was made after monitoring day 7
  * Confirmed at least two separate blood pressure ≥130/80 mm Hg at the end of the 14-day rBPM period
  * Ability and willingness to participate in home visits and remote monitoring
  * Able to communicate in English or Spanish without the need for interpretation services

Exclusion Criteria:

* • Inability to provide informed consent

  * Physician determination of inability to measure blood pressure at home due to comorbidities or other limiting conditions
  * No access to a phone

• Vijay A, Oh I, Lewis A, Sabol BA, Frolova AI, Huffman MD, Mahmoud Z, Rampersad R. Postpartum blood pressure monitoring across hypertensive disorders of pregnancy. Pregnancy Hypertens. 2026 Sep 8;46:101520. doi: 10.1016/j.preghy.2026.101520. Online ahead of print. PMID 42710173

• Study Protocol and Statistical Analysis Plan (PDF, 2026-01-13)
• Informed Consent Form (PDF, 2026-06-01)

• Aishwarya Vijay, MD, Principal investigator, Washington University School of Medicine

NIH grants: T32HL007081