Home BP monitoring pilot program shows benefits of intensive follow-up after delivery
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Key takeaways:
- Women with postpartum hypertension achieved BP control after participating in an at-home BP monitoring program.
- Some women opted out of the program due to time constraints.
In a pilot program for women with hypertension after delivery, at-home BP monitoring and medication titration to a systolic BP of less than 130 mm Hg was associated with 95% of participants achieving optimal BP control 6 weeks postpartum.
“Hypertensive disorders of pregnancy are a leading cause of postpartum readmission, morbidity and mortality,” Amy A. Sarma, MD, MHS, cardiologist in the Corrigan Women’s Heart Health Center at Massachusetts General Hospital and instructor in medicine at Harvard Medical School, and colleagues wrote in JACC Advances. “There is significant interest in BP home monitoring for outpatient postpartum hypertension management, but optimal frequency, duration and BP targets have not been established.”
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Sarna and colleagues analyzed data from 62 postpartum women who delivered at Massachusetts General Hospital from February to May 2021 with a diagnosis of chronic hypertension (23%), gestational hypertension (45%) or preeclampsia (31%), all recruited at labor hospitalization.
Researchers provided participants who did not own BP cuffs with an automatic cuff and educational materials on BP self-measurement. After discharge, participants reported self-measured BP and received daily feedback, including medication initiation/titration according to a study algorithm that targeted a BP of less than 130/80 mm Hg by 6 weeks postpartum.
If diastolic BP remained higher than 80 mm Hg after systolic BP control, researchers monitored patients more closely and a single medication dose increase was made for isolated diastolic hypertension. When pharmacotherapy was indicated, nifedipine XL was used first-line, followed by labetalol and enalapril. After 5 consecutive days of BP stability, monitoring was reduced to weekly. The primary outcome was postpartum hospital readmission within 6 weeks; secondary outcomes included BP at 6 weeks and frequency of medication titration.
Among 42 participants who completed the intervention, 7% were readmitted for hypertension, all within the first week after discharge (compared with 10% among a historical cohort). Within the cohort, 95% achieved a systolic BP of less than 130 mm Hg by 6 weeks postpartum. At 6 weeks postpartum, 31% remained on antihypertensive therapy.
“To achieve control, 50% of patients with chronic hypertension and 23% with preeclampsia required more than a single agent, with one patient with preeclampsia requiring three simultaneous medications,” the researchers wrote. “At the study’s conclusion, only one participant (with chronic hypertension) required two medications.”
Among 39 participants who completed a survey after the program, 82% reported that daily monitoring improved postpartum care. However, 15% reported that daily monitoring increased stress, and 8% reported that daily phone calls were inconvenient. Of the 18 patients who were eligible but declined study participation, 61% cited a lack of time, and 17% cited concerns regarding home BP monitoring, according to the researchers.
“Monitoring frequency was designed to be significantly greater than currently recommended by American College of Obstetricians and Gynecologists and demonstrated a need for high-frequency clinical intervention in weeks 1 to 3 after hospital discharge,” the researchers wrote. “The BP target was chosen to align with American College of Cardiology/American Heart Association recommendations for nonpregnant patients, especially in light of mounting evidence that hypertensive disorders of pregnancy increases later-life CVD risk, largely mediated through hypertension. Indeed, a significant proportion (31%) of participants required antihypertensives at 6 weeks to achieve normotension as defined by the ACC/AHA.”
The researchers noted that despite attempts to remove barriers for participation, including native-language speakers for Spanish-speaking participants, a remote monitoring strategy and monitoring via phone calls, only 68% of participants completed the study, demonstrating a need for investigations into strategies that optimize patient engagement among diverse cohorts.
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