Remote postpartum BP monitoring could address gaps in care, cut heart disease risk
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Key takeaways:
- Longer-term remote postpartum BP monitoring was associated with improved BP control after a hypertensive disorder of pregnancy.
- Program participants were more likely to follow up with a primary care physician.
ATLANTA — Implementing a remote postpartum BP monitoring program for women with persistent hypertension after delivery was shown to be feasible and linked to higher rates of primary care provider visits and BP control, researchers reported.
Hypertensive disorders of pregnancy are associated with high rates of postpartum hypertension, and data show that half of women have persistent hypertension at 6 weeks postpartum, Anisha R. Reddy, MD, a medical resident at University of Pittsburgh Medical Center, said during a moderated poster theater at the American College of Cardiology Scientific Session. The researchers assessed the feasibility of a text-based remote BP management program that leveraged an existing postpartum remote monitoring program, extending BP monitoring from 6 weeks up to 1 year.
By the conclusion of the 1-year extended program, 92% of participants had a BP of 140/90 mm Hg or less, compared with 71% of participants at the conclusion of the 6-week program, Reddy said.
“Hypertensive disorders of pregnancy often lead to postpartum hypertension,” Reddy told Healio. “There is an untreated population because it can be difficult during the postpartum period to go to in-person clinic visits. This can lead to chronic hypertension and increased risk for CVD. We wanted to design an innovative method to monitor BP during the postpartum period.”
Reddy and colleagues analyzed data from 1,318 women who opted in for the extended remote BP monitoring program vs. 2,344 women who participated in the same program only up to 6 weeks postpartum.
"Our program initially offered 6-week remote BP monitoring and we found that about 50% of women had suboptimally treated hypertension at the end of the 6-week period,” Reddy told Healio. “That is why we decided to extend [the program] to 1 year.”
Women who qualified for the remote monitoring program had persistent hypertension, defined as an ongoing need for antihypertensive medications and/or a BP greater than 130/90 mm Hg at 3 weeks postpartum. The mean age of participants was 33 years; 22% of participants were Black and 32% had public insurance.
“Patients receive a text message reminder with a link to web page, where they are able to enter their BPs,” Malamo Countouris, MD, MS, assistant professor of medicine and co-director of the postpartum hypertension program at University of Pittsburgh Medical Center, told Healio. “We want to make it as easy as possible for the patients. Participants also had the opportunity to download an app, which can help facilitate optimizing how many people are entering BP levels.”
After opting in for the extended monitoring, 61% of participants entered at least one BP measurement (mean, 57 BPs entered) and participated for a median of 23 weeks after delivery. At the end of the extended monitoring program, for those in the extension group, final mean BP at the conclusion of extended monitoring was 121/79 mm Hg compared with 125/82 mm Hg at the end of the 6-week program.
The extension group had higher rates of PCP follow-up within 18 months postpartum compared with those in the 6-week program (46% vs. 39%; P < .001), as well as more visits to a postpartum hypertension clinic (20% vs. 2%; P < .001).
Reddy said data show that BP monitoring beyond the initial 6-week postpartum period may address gaps in care and could potentially reduce CV risk. Reddy noted that, even within a robust program, only a minority of the participants with persistent hypertension participated in extended monitoring and had a PCP visit, highlighting the importance of ongoing innovative approaches to engagement in care.
“We were able to capture a very racially and socioeconomically diverse cohort,” Reddy said. “We have to assess the barriers some of these patients face to follow up with their PCP. Are they having a hard time logistically, with scheduling? Is there not enough patient education?”
Countouris said the data show that remote monitoring can improve BP for postpartum women.
"Some of [the lower BPs at 1 year] may be due to recovery over time, but we suspect that a lot of it is related to being involved in the program. There are opportunities to optimize the number of people who participate. There are still only about 40% of women opting-in for extended monitoring that have persistent hypertension at 6 weeks. We need to do a better job of encouraging people to participate.”
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Reddy AR, et al. Abstract 1021-11. Presented at: American College of Cardiology Scientific Session; April 6-8, 2024; Atlanta.
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