Self-monitoring of BP does not improve diagnosis, management of high-risk pregnant women
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Compared with the usual care, self-monitoring of BP did not improve diagnosis of hypertension or control of BP in high-risk pregnant women, according to two trials published in JAMA.
The BUMP 1 trial evaluated whether self-monitoring of BP with telemonitoring could enable earlier clinic-based diagnosis of hypertension in pregnant women at elevated risk for preeclampsia, whereas the BUMP 2 trial evaluated whether self-monitoring of BP with telemonitoring could improve clinic-based BP control in pregnant women with chronic or gestational hypertension.
BUMP 1
For the BUMP 1 trial, researchers enrolled 2,441 pregnant women at elevated risk for preeclampsia (mean age, 33 years; mean gestation at recruitment, 20 weeks) and randomly assigned them to BP self-monitoring with telemonitoring or the usual care.
The primary outcome was time to first recorded hypertension as measured by a health care professional. Among the cohort, 96% completed the trial.
Mean time from randomization to recorded hypertension in the clinic did not differ between the BP self-monitoring group (104.3 days; standard deviation, 32.6) and the control group (106.2 days; standard deviation, 32; mean difference, –1.6 days; 95% CI, –8.1 to 4.9; P = .64), Katherine L. Tucker, PhD, senior researcher in the Nuffield department of primary care health sciences, University of Oxford, U.K., and colleagues wrote.
Serious adverse events occurred in 1% of the BP self-monitoring group and 0.5% of the control group, but none of the events were related to the intervention, according to the researchers.
“Although very small differences cannot be ruled out, self-monitoring did not result in a clinically important or statistically significant earlier presentation of hypertension,” Tucker and colleagues wrote.
BUMP 2
For the BUMP 2 trial, the researchers randomly assigned 850 pregnant women with chronic (n = 454; mean age, 36 years; mean gestation at randomization, 20 weeks) or gestational (n = 396; mean age, 34 years; mean gestation at randomization, 33 weeks) hypertension to BP self-monitoring using a validated monitor and a secure telemonitoring system plus the usual care or the usual care alone.
The primary outcome was difference in systolic BP recorded by a health care professional between randomization and birth. Approximately 96% of the cohort completed the trial.
In those with chronic hypertension, systolic BP was almost identical in both groups (self-monitoring BP group, 133.8 mm Hg; control group, 133.6 mm Hg; adjusted mean difference, 0.03 mm Hg; 95% CI, –1.73 to 1.79), Lucy C. Chappell, MB BChir, PhD, NIHR research professor in obstetrics at King’s College London and honorary consultant obstetrician at Guy’s and St Thomas’ NHS Foundation Trust, and colleagues wrote.
There were similar results in those with gestational hypertension (self-monitoring BP group, 137.6 mm Hg; control group, 137.2 mm Hg; adjusted mean difference, –0.03 mm Hg; 95% CI, –2.29 to 2.24), according to the researchers.
There were few adverse events in either group.
“These results were similar for all subgroups including those with gestational hypertension, whether they were recruited directly into the trial or transitioned from the
linked trial when they developed hypertension,” Chappell and colleagues wrote.
More research needed
In a related editorial, Malavika Prabhu, MD, assistant professor of obstetrics and gynecology at Weill Cornell Medicine, and colleagues wrote: “Data from BUMP 1 are compelling enough for clinicians to curb their enthusiasm about generalizing self-monitoring of BP to all individuals with an elevated risk of preeclampsia” and that “While data from BUMP 2 demonstrate that with well-controlled hypertension, additional self-monitoring of BP does not improve BP control, the effects on perinatal outcomes or utility for individuals with higher BPs are unknown.”
They also noted that self-monitoring of BP “requires access to a reliable BP cuff, a smartphone to record the data in an app, and the ability to communicate with a clinician providing prenatal care, all of which may not be equally accessible to all pregnant persons. More research is needed to determine optimal, high-value, equitable approaches to averting adverse perinatal outcomes associated with hypertensive disorders of pregnancy.”
References:
- Chappell LC, et al. JAMA. 2022;doi:10.1001/jama.2022.4726.
- Prabhu M, et al. JAMA. 2022;doi:10.1001/jama.2022.2802.
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