# The ACHIEVE Trial: Achieving longer gestation in preeclampsia via antihypertensive therapy.

> **NIH NIH K23** · UNIVERSITY OF ALABAMA AT BIRMINGHAM · 2022 · $191,376

## Abstract

ABSTRACT
Dr. Rachel G. Sinkey is a maternal-fetal medicine subspecialist who seeks to become an independently funded
clinician-scientist focused on hypertension and cardiovascular (CVD) disease in pregnancy and the postpartum
period. She seeks a K23 Mentored Research Award to realize this goal and has assembled a team of world-
renowned experts to provide mentorship as she completes a tailored, five-year career development and
mentored research plan. In the comprehensive career development plan the candidate will: 1) obtain skills to
independently design and conduct clinical trials; 2) complete a Master of Science in Public Health degree; 3)
attain contemporary hypertension knowledge, and 4) obtain career skills in strategic grant planning and writing.
The customized career development plan will be accompanied by a mentored randomized clinical trial focused
on preeclampsia. Preeclampsia (PE) is a hypertensive disorder that occurs in the second half of pregnancy,
complicating up to one in twelve pregnancies. Delivery immediately following PE diagnosis carries the least
maternal risk; however, when possible, delivery is delayed if the gestation is preterm (<37 weeks) to decrease
major effects of prematurity. Despite this, maternal or fetal health factors may lead to delivery of a preterm patient
with PE including: 1) maternal end-organ damage or uncontrolled severe hypertension (known as severe PE),
and 2) fetal abnormalities (involving amniotic fluid, fetal testing and/or uterine artery Dopplers). The American
College of Cardiology/American Heart Association Hypertension Guideline defers pregnancy hypertension
management to the American College of Obstetricians and Gynecologists (ACOG). ACOG recommends
antihypertensive treatment for severe hypertension (BP ≥160/110 mmHg), to avoid acute cardiovascular
complications. On the other hand, treatment of non-severe hypertension in women with PE is controversial, due
to concerns that lowering arterial perfusion to the fetus may lead to impaired fetal growth. There is also concern
that anti-hypertensive therapy may mask severe PE, leading to maternal harm. Evidence supporting these
concerns is limited, and it is unknown whether antihypertensive treatment safely prolongs pregnancy, a
prerequisite for neonatal benefit. Given these critical gaps in knowledge, we propose “The ACHIEVE Trial”,
a phase II, open-label RCT (N=132) of antihypertensive treatment in preterm patients with non-severe PE.
Participants will be randomized 1:1 to: 1) intervention – anti-hypertensive therapy for BP goal <140/90 mmHg,
or 2) usual care – antihypertensive therapy only if BP ≥160/110 mmHg. In Aim 1 we will determine if treatment
to achieve a BP goal <140/90 mmHg prolongs mean time to delivery. In Aim 2 we will examine whether the
intervention reduces perinatal and maternal morbidity. We will also collect and store blood for future studies
investigating CVD biomarkers and endothelial dysfunction. This research study, accompanied ...

## Key facts

- **NIH application ID:** 10448650
- **Project number:** 1K23HL159331-01A1
- **Recipient organization:** UNIVERSITY OF ALABAMA AT BIRMINGHAM
- **Principal Investigator:** Rachel G Sinkey
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $191,376
- **Award type:** 1
- **Project period:** 2022-07-15 → 2027-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10448650

## Citation

> US National Institutes of Health, RePORTER application 10448650, The ACHIEVE Trial: Achieving longer gestation in preeclampsia via antihypertensive therapy. (1K23HL159331-01A1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10448650. Licensed CC0.

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