Effect of Self-monitoring of Blood Pressure on Blood Pressure Control in Pregnant Individuals With Chronic or Gestational Hypertension

Chappell, Lucy C; Tucker, Katherine L.; Galal, Ushma; Yu, Ly-Mee; Campbell, Helen; Rivero‐Arias, Oliver; Allen, Julie; Band, Rebecca; Chisholm, Alison; Crawford, Carole; Dougall, Greig; Engonidou, Lazarina; Franssen, Marloes; Green, Marcus; Greenfield, Sheila; Hinton, Lisa; Hodgkinson, James; Lavallee, Layla; Leeson, Paul; McCourt, Christine; Mackillop, Lucy; Sandall, Jane; Santos, Mauro; Tarassenko, Lionel; Velardo, Carmelo; Wilson, Hannah; Yardley, Lucy; McManus, Richard J

doi:10.1001/jama.2022.4726

Cited by 50 publications

(58 citation statements)

References 34 publications

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“…The Blood Pressure Monitoring in High-Risk Pregnancy to Improve the Detection and Monitoring of Hypertension (BUMP 1 and BUMP 2) unblinded randomised controlled trials assessed the effect of self-monitoring of blood pressure (SMBP) compared with usual care 1 2…”

Section: Overviewmentioning

confidence: 99%

“…The BUMP 2 trial compared SMBP with usual care for pregnant women with either chronic hypertension (defined as sustained systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg present at booking or before 20 weeks’ gestation, or use of antihypertensive treatment outside of pregnancy or at the time of referral) or gestational hypertension (defined as sustained systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg after 20 weeks’ gestation) 2. The SMBP and usual care interventions were the same as in the BUMP 1 study, but with clinicians allowed to initiate or adjust antihypertensive treatment where necessary, and women in the usual care arm were allowed to self-monitor their blood pressure but did not receive any advice or training on self-monitoring or the study device and app.…”

Section: Overviewmentioning

confidence: 99%

“…A total of 850 pregnant women (‘White’ 59%, ‘Black or Black British’ 20%, ‘Asian or British Asian’ 12%) with hypertension were randomised (454 with chronic hypertension and 396 with gestational hypertension) to receive SMBP (n=430) or usual care (n=420) 2. The mean age of women with chronic hypertension was 36 years and 66% had monitored their own blood pressure during the pregnancy.…”

Section: Overviewmentioning

confidence: 99%

“…The BUMP trials were designed to determine whether SMBP could improve detection of hypertension in women at high risk of pre-eclampsia and management of hypertension during pregnancy 1 2. The studies found that SMBP did not result in earlier diagnosis of hypertension or better blood pressure control.…”

Section: Contextmentioning

confidence: 99%

“…Two randomised controlled trials that evaluated self-monitoring of blood pressure (SMBP) in pregnant women at risk of, or with, hypertension reported no benefit over usual care in detecting hypertension earlier or improving blood pressure (BP) control 1 2…”

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confidence: 99%

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Effect of self-monitoring blood pressure in pregnancy

2022

DTB

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Overview of: Tucker KL, Mort S, Yu LM, et al. Effect of self-monitoring of blood pressure on diagnosis of hypertension during higher-risk pregnancy: the BUMP 1 randomized clinical trial. JAMA. 2022;327:1656–65; and Chappell LC, Tucker KL, Galal U, et al. Effect of self-monitoring of blood pressure on blood pressure control in pregnant individuals with chronic or gestational hypertension: the BUMP 2 randomized clinical trial. JAMA. 2022;327:1666–78.

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confidence: 99%

Section: Overviewmentioning

confidence: 99%

Section: Overviewmentioning

confidence: 99%

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Effect of self-monitoring blood pressure in pregnancy

2022

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Postpartum Ambulatory Blood Pressure Patterns Following New-Onset Hypertensive Disorders of Pregnancy

Hauspurg,

Venkatakrishnan,

Collins

et al. 2024

JAMA Cardiol

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ImportanceAfter a hypertensive disorder of pregnancy, hypertension can worsen in the postpartum period following hospital discharge. Risk factors for ongoing hypertension and associated outcomes have not been well characterized.ObjectiveTo identify risk factors and characterize outcomes for individuals with ongoing hypertension and severe hypertension following hospital discharge post partum through a hospital system’s remote blood pressure (BP) management program.Design, Setting, and ParticipantsThis cohort study involved a population-based sample of individuals with a new-onset hypertensive disorder of pregnancy (preeclampsia or gestational hypertension) and no prepregnancy hypertension who delivered between September 2019 and June 2021. Participants were enrolled in a remote BP monitoring and management program at a postpartum unit at a referral hospital. Data analysis was performed from August 2021 to January 2023.ExposureInpatient postpartum BP categories.Main Outcomes and MeasuresThe primary outcomes were readmission and emergency department visits within the first 6 weeks post partum. Logistic regression was used to model adjusted odds ratios (aORs) and 95% CIs.ResultsOf 2705 individuals in the cohort (mean [SD] age, 29.8 [5.7] years), 2214 (81.8%) had persistent hypertension post partum after hospital discharge, 382 (14.1%) developed severe hypertension after discharge, and 610 (22.6%) had antihypertensive medication initiated after discharge. Individuals with severe hypertension had increased odds of postpartum emergency department visits (aOR, 1.85; 95% CI, 1.17-2.92) and hospital readmissions (aOR, 6.75; 95% CI, 3.43-13.29) compared with individuals with BP normalization. When inpatient postpartum BP categories were compared with outpatient home BP trajectories to inform optimal thresholds for inpatient antihypertensive medication initiation, there was significant overlap between postdischarge BP trajectories among those with inpatient systolic BP greater than or equal to 140 to 149 mm Hg and/or diastolic BP greater than or equal to 90 to 99 mm Hg and those with systolic BP greater than or equal to 150 mm Hg and/or diastolic BP greater than or equal to 100 mm Hg.Conclusions and RelevanceThis cohort study found that more than 80% of individuals with hypertensive disorders of pregnancy had ongoing hypertension after hospital discharge, with approximately 14% developing severe hypertension. These data support the critical role of remote BP monitoring programs and highlight the need for improved tools for risk stratification and consideration of liberalization of thresholds for medication initiation post partum.

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Integrating technologies to provide comprehensive remote fetal surveillance: A prospective pilot study

Nir,

Dvir,

Galler

et al. 2023

Intl J Gynecology & Obste

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ObjectiveTo determine the feasibility of extending remote maternal‐fetal care to include fetus well‐being.MethodsThe authors performed a prospective pilot study investigating low‐risk pregnant participants who were recruited at the time of their first full‐term in‐person visit and scheduled for a follow‐up telemedicine visit. Using novel self‐operated fetal monitoring and ultrasound devices, fetal heart monitoring and amniotic fluid volume measurements were obtained to complete a modified biophysical profile (mBPP). Total visit length was measured for both the in‐person first visit and the subsequent telemedicine encounter. A patient satisfaction survey form was obtained.ResultsTen women between 40 + 1 and 40 + 6 weeks of gestation participated in telemedicine encounters. Nine women (90%) were able to complete remote mBPP assessment. For one participant, fetal assessment was not completed due to technically inconclusive fetal monitoring. Another participant was referred for additional assessment in the delivery room. Satisfactory amniotic fluid volume measurements were achieved in 100% of participants. The telemedicine encounter was significantly shorter (93.1 ± 33.1 min) than the in‐person visit (247.2 ± 104.7 min; P < 0.001). We observed high patient satisfaction.ConclusionRemote fetal well‐being assessment is feasible and time‐saving and results in high patient satisfaction. This novel paradigm of comprehensive remote maternal and fetal assessment is associated with important clinical, socioeconomic, and logistics advantages.

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Effect of Self-monitoring of Blood Pressure on Blood Pressure Control in Pregnant Individuals With Chronic or Gestational Hypertension

Abstract: Please refer to any applicable terms of use of the publisher.

Cited by 50 publications

References 34 publications

Effect of self-monitoring blood pressure in pregnancy

Effect of self-monitoring blood pressure in pregnancy

Postpartum Ambulatory Blood Pressure Patterns Following New-Onset Hypertensive Disorders of Pregnancy

Integrating technologies to provide comprehensive remote fetal surveillance: A prospective pilot study

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