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Effect of Self-Monitoring BP in Pregnancy-Related Hypertension
Quick Takes
- Self-monitoring with telemonitoring was not significantly different compared to usual care for blood pressure (BP) control among pregnant women with elevated BP.
- No difference in adverse events was observed between the two groups.
Study Questions:
Does blood pressure (BP) self-monitoring compared with usual care (UC) improve maternal BP in women with pregnancy-related hypertension?
Methods:
Data from the BUMP 2 (Blood Pressure Monitoring in High Risk Pregnancy to Improve the Detection and Monitoring of Hypertension 2) trial was examined to determine the impact of a self-monitoring intervention. Women were recruited between November 2018 and September 2019 from 15 hospital maternity units in England. Pregnant adults with chronic hypertension (HTN) or gestational HTN were included and followed through May 2020. Those in the intervention group received a validated BP monitor and a secure telemonitoring system, while the control group received UC (i.e., BP measured at regular antenatal clinics). The primary outcome was maternal difference in mean systolic BP recorded by health care professionals between randomization and birth.
Results:
A total of 454 participants with chronic HTN (mean age, 36 years; mean gestation at entry, 20 weeks) and 396 with gestational HTN (mean age, 34 years; mean gestation at entry, 33 weeks) were included in the randomized controlled trial. Primary outcome data were available from 444 (97.8%) and 377 (95.2%), respectively. In the chronic HTN cohort, there was no statistically significant difference in mean systolic BP for the self-monitoring groups versus the UC group (133.8 mm Hg vs. 133.6 mm Hg, respectively; adjusted mean difference, 0.03 mm Hg [95% confidence interval, −1.73 to 1.79]). In the gestational HTN cohort, there was also no significant difference in mean systolic BP (137.6 mm Hg compared with 137.2 mm Hg; adjusted mean difference, −0.03 mm Hg [95% confidence interval, −2.29 to 2.24]). There were eight serious adverse events in the self-monitoring group (four in each cohort) and three in the UC group (two in the chronic HTN cohort and one in the gestational HTN cohort).
Conclusions:
The investigators concluded that among pregnant individuals with chronic or gestational HTN, BP self-monitoring with telemonitoring, compared with UC, did not significantly improve clinic-based BP control.
Perspective:
These data do not support BP self-monitoring among pregnant women with elevated BP. However, as the authors note, the UC group may have also used home BP monitors, diluting the intervention’s effects.
Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Vascular Medicine, Hypertension
Keywords: Blood Pressure, Blood Pressure Monitoring, Ambulatory, Blood Pressure Monitors, Health Personnel, Hypertension, Pregnancy-Induced, Pregnancy, Pregnancy, High-Risk, Pregnant Women, Secondary Prevention, Women
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