This article was authored by Elizabeth Le, MD, FACC, cardiologist at the VA Portland Health Care System in Portland, OR.

Natalie Bello, MD, is a multi-modality imaging expert and assistant professor of medicine at Columbia University Medical Center in New York. Her research is focused on better understanding the relationship between hypertensive disorders during pregnancy and future cardiovascular risk. Last year, Bello was awarded the ACC/William F. Keating Esq. Endowment Career Development Award to examine whether home blood pressure monitoring can be used to guide the management of hypertension during pregnancy and reduce adverse maternal-fetal events.

Chronic hypertension in pregnancy, defined as elevated blood pressure prior to 20 weeks gestation, is associated with substantial maternal-fetal morbidity and mortality. It is the most common disorder encountered by obstetricians, and the prevalence is rising in tandem with rates of obesity and advanced maternal age. Current guidelines recommend that women maintain a blood pressure of less than 160/105 mm Hg during pregnancy. The ideal target blood pressure during pregnancy remains uncertain, and both over- and under-treatment of hypertension during pregnancy may be associated with an increased risk of adverse outcomes.

Decisions surrounding antihypertensive medication intensification in pregnancy are primarily based on blood pressure in the clinic, which is a poor surrogate for a patient’s “true” blood pressure in the natural environment. In comparison, out-of-clinic blood pressure monitoring, including 24-hour ambulatory and home blood pressure monitoring, better estimate a patient’s long-term blood pressure level.

As out-of-clinic blood pressure likely reflects placental perfusion better than in-clinic blood pressure, out-of-clinic monitoring may guide the decision to intensify antihypertensive medication only in women who stand to benefit. Home blood pressure monitoring is ideally suited for assessing out-of-clinic blood pressure among pregnant women with chronic hypertension. Home blood pressure monitoring captures blood pressure over several days, is well-tolerated, has excellent reproducibility and is widely available. Further, home blood pressure monitors have been validated for use in pregnant women, but ambulatory monitors have not been.

Bello plans to study the use of home blood pressure monitoring in pregnant women with hypertension and hopes to shape how care is delivered to this high-risk population. The receipt of this award is a great honor, and Bello is very appreciative of ACC’s efforts to help early career physician-scientists obtain funding during a vulnerable career stage in academic medicine.