Home blood pressure monitoring may improve overall postpartum BP determination

Key takeaways:

• Home BP monitoring increased the likelihood of at least one BP measurement during the first 10 postpartum days.
• Home BP monitoring was associated with a 50% reduction in racial disparities when ascertaining BP.

Postpartum blood pressure monitoring at home compared with clinic may improve BP ascertainment and may reduce racial disparities observed in office-based follow-up, according to a systematic review published in Obstetrics & Gynecology.

“This systematic review sought evidence regarding the effectiveness and harms of home BP monitoring, with or without remote monitoring, compared with traditional clinic-based BP checks; and the comparative effectiveness and harms of various home BP-monitoring implementations in improving clinical outcomes and reducing existing disparities,” Dale W. Steele, MD, MSc, professor of emergency medicine, pediatrics, and health services, policy and practice at the Warren Alpert Medical School of Brown University, and colleagues wrote.

In a systematic review, Steele and colleagues searched MEDLINE, Cochrane, Embase, CINAHL and ClinicalTrials.gov from inception to December 2022 and identified three randomized controlled trials, two nonrandomized comparative studies and eight single-arm studies evaluating the effects of home BP monitoring for postpartum women. All comparative studies enrolled women with hypertensive disorders of pregnancy. All studies assessed home BP monitoring during the postpartum period of up to 1 year after delivery with or without telemonitoring on postpartum maternal and infant outcomes, health care utilization and harm outcomes.

In one randomized controlled trial that compared home BP monitoring with bidirectional text messaging with scheduled clinic-based BP visits, researchers observed an increased likelihood of at least one ascertained BP measurement during the first 10 days postpartum for those using home BP monitoring (RR = 2.11; 95% CI, 1.68-2.65). Similar findings were observed in a nonrandomized comparative study (adjusted RR = 1.59; 95% CI, 1.36-1.77).

Home BP monitoring was not associated with the rate of initiating BP treatment (aRR = 1.03; 95% CI, 0.74-1.44). However, home BP monitoring was associated with reduced unplanned hypertension-related hospital admissions (aRR = 0.12; 95% CI, 0.01-0.96).

Overall, 83.3% to 87% of postpartum women were satisfied with home BP monitoring management. Compared with office-based follow-up, home BP monitoring was associated with about a 50% reduction in racial disparities when ascertaining BP.

“Home BP monitoring in postpartum individuals probably improves ascertainment of BP, allowing early recognition of hypertension and probably compensates for racial disparities in office-based follow-up,” the researchers wrote. “There is insufficient evidence to conclude whether home BP monitoring reduces severe maternal morbidity or mortality or racial disparities in clinical outcomes.”