Effect of Self-monitoring of Blood Pressure on Diagnosis of Hypertension During Higher-Risk Pregnancy

Abstract

Question: Does self-monitoring of blood pressure by pregnant individuals at higher risk of preeclampsia lead to earlier detection of pregnancy hypertension compared to usual antenatal care? Findings: In this randomized clinical trial that included 2441 pregnant individuals at increased risk for pre-eclampsia, use of self-monitoring of BP with telemonitoring compared with usual care resulted in a mean time to clinic-based detection of hypertension of 104 vs 106 days, a difference that was not statistically significant.Meaning: Among pregnant individuals at higher risk of pre-eclampsia, blood pressure selfmonitoring with telemonitoring did not lead to earlier clinic-based detection of hypertension.

Effect of self-monitoring blood pressure in pregnancy

“…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…”

“…BUMP 1 recruited pregnant women (16–24 weeks’ gestation) at increased risk of pre-eclampsia as defined by UK guidance and who did not have a diagnosis of hypertension 1. Participants were recruited from 15 hospital maternity sites in England and randomised to either usual care (n=1218) or usual care with SMBP plus telemonitoring (n=1223).…”

“…Participants (‘White’ 74%, ‘Asian or British Asian’ 10%, ‘Black or Black British’ 8%) had a mean age of 33 years, mean gestation at recruitment of 20 weeks and were fairly evenly spread across five levels of deprivation 1. A quarter of participants reported that they had previously measured their own blood pressure.…”

“…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.…”

“…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…”