Home blood‐pressure monitoring in a hypertensive pregnant population

Perry, Helen; Sheehan, Elaine; Thilaganathan, B.; Khalil, Asma

doi:10.1002/uog.19023

Cited by 66 publications

(88 citation statements)

References 27 publications

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“…With the advent of smartphones and evolving technologies, home blood pressure monitoring may become the mainstay of the management of hypertensive diseases both during the pregnancy and postnatally in the community [37, 38]. This will hopefully achieve better blood pressure control and reduce the need for as many hospital visits without jeopardising maternal and fetal outcomes [38].…”

Section: Discussionmentioning

confidence: 99%

“…This will hopefully achieve better blood pressure control and reduce the need for as many hospital visits without jeopardising maternal and fetal outcomes [38]. …”

Section: Discussionmentioning

confidence: 99%

“…As a secondary effect, it may also reduce the number of visits to hospital in the context of outpatient monitoring and provide a more acceptable way for women to monitor their blood pressure [38]. There is evidence that home blood pressure monitoring is safe provided the reference ranges for target blood pressures are lower than in the clinic setting [37, 38]. In obese pregnant women, the use of an appropriate sized cuff is important in ensuring accurate blood pressure readings [20].…”

Section: Home Blood Pressure Monitoringmentioning

confidence: 99%

“…There is no particular mention regarding any difference in the choice of antihypertensive therapy in the obese pregnant woman. With the adjunct of a home blood pressure monitor that has been validated for use in pregnancy and a specially designed smartphone app, women’s blood pressure can be monitored remotely and antihypertensive treatment can be titrated appropriately without compromising safety [38]. This innovative pathway has also been shown to be cost saving in UK NHS healthcare setting [40].…”

Section: Home Blood Pressure Monitoringmentioning

confidence: 99%

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Management of Hypertension in the Obese Pregnant Patient

Coroyannakis

Khalil

2019

Curr Hypertens Rep

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Purpose of ReviewTo evaluate recent developments in the management of hypertension in obese pregnant women.Recent FindingsThe mainstay of management targets prevention of hypertension with preconception counselling, entering pregnancy with a lower BMI, limiting weight gain, and taking low-dose aspirin to prevent pre-eclampsia from before 16 weeks’ gestation. There are conflicting results regarding the use of metformin in reducing hypertensive disease, but there is a high probability that it has a role to play. Clinical trials are in progress examining the use of statins in preventing pre-eclampsia, with promising results from pre-clinical trials. Home blood pressure monitoring may be helpful in diagnosing and monitoring the control of hypertension.SummaryThe most protective interventions against hypertensive disease in obese pregnant women are entering pregnancy at a lower BMI, avoiding inter-pregnancy weight gain, and taking low-dose aspirin during pregnancy. Further research is needed around the use of metformin, statins, and home blood pressure monitoring.

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Section: Discussionmentioning

confidence: 99%

“…This will hopefully achieve better blood pressure control and reduce the need for as many hospital visits without jeopardising maternal and fetal outcomes [38]. …”

Section: Discussionmentioning

confidence: 99%

Section: Home Blood Pressure Monitoringmentioning

confidence: 99%

Section: Home Blood Pressure Monitoringmentioning

confidence: 99%

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Management of Hypertension in the Obese Pregnant Patient

Coroyannakis

Khalil

2019

Curr Hypertens Rep

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“…The potential benefits of HBPM in pregnancy include earlier detection of pre-eclampsia, convenience for the pregnant woman and reduced healthcare costs, as well as increased compliance with and acceptance of monitoring [8][9][10][11] . Our recent work has demonstrated that HBPM reduces the number of hospital visits without compromising maternal and fetal outcomes 9 . Furthermore, HBPM was found to be cost-effective, with an average saving per week of £286.53 in the group of women following HBPM using a dedicated app, compared with those undergoing traditional monitoring at the hospital/clinic 8 .…”

Section: Introductionmentioning

confidence: 99%

Is home blood‐pressure monitoring in hypertensive disorders of pregnancy consistent with clinic recordings?

Kalafat

Mir

Thilaganathan

et al. 2018

Ultrasound in Obstet & Gyne

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Our study shows that, in women with HDP, blood pressure measured at home is lower than that measured in a clinic setting. This is consistent with observations in non-pregnant adults, in whom home and ambulatory monitoring of hypertensive patients is recommended. As such, HBPM has the potential to reduce the number of false-positive diagnoses of severe hypertension and unnecessary medical interventions in women with HDP. This must be carefully weighed against the risk of missing true-positive diagnoses. Prospective studies investigating the use of HBPM in pregnant women are urgently needed to determine the relevant blood-pressure thresholds for HBPM, and interval and frequency of monitoring. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

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Remote blood pressure monitoring in women at risk of or with hypertensive disorders of pregnancy: A systematic review and meta‐analysis

Rajkumar,

Hennessy,

Makris

2024

Intl J Gynecology & Obste

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BackgroundRemote blood pressure monitoring refers to an organized framework that either allows clinicians to review home‐based blood pressure readings and institute management, or provide participants with clear instructions for contacting care teams when blood pressure readings are out of prespecified targets. With widespread uptake of telemonitoring and mobile health in recent years, such models of care have been increasingly described in the literature.ObjectivesThis study aimed to review remote blood pressure monitoring in pregnant and postpartum women who are at high‐risk for or have an established diagnosis of hypertensive disorders of pregnancy, and its effect on maternal and fetal outcomes, healthcare utilization and psychosocial outcomes.Search strategyPubMed, Medline, Embase, Cochrane Library, Web of Science and CINAHL databases were searched electronically in June 2024 to their inception.Study selection criteriaIncluded studies compared remote blood pressure monitoring with standard care. Remote blood pressure monitoring was pre‐defined as any framework for measuring blood pressure remotely in pregnancy, with organized review by clinicians. Published full‐text and study abstracts describing randomized controlled trials and observational studies were included.The study population was pregnant women at high‐risk for developing pre‐eclampsia or postpartum (<6 weeks) women with an established diagnosis of a hypertensive disorder of pregnancy. Remote blood pressure monitoring undertaken in the antenatal and postnatal periods were analyzed separately.Data collection and analysisThis systematic review was conducted according to the Preferred Reporting Item for Systematic Reviews and Meta‐Analyses statement. Screening of records and data extraction were independently performed. Data were extracted and analyzed using Review Manager software (version 5.4; Cochrane Collaboration, Copenhagen, Denmark). Risk of bias and quality assessment was performed independently using the Risk Of Bias In Non‐randomized Studies‐of Interventions (ROBINS‐I) assessment tool and the Cochrane Risk of Bias 2 (RoB2) tool.Main resultsA total of 18 studies with 28 094 patients were included. Antenatal remote blood pressure monitoring reduces antenatal outpatient visits, antenatal hospital admissions for any cause, and antenatal hospital admissions specifically for hypertension. Importantly, there was no increase in adverse maternal and fetal outcomes, including the likelihood of cesarean section deliveries or induction of labor due to hypertension, composite maternal outcome, growth restriction, neonatal intensive care unit admissions, gestational age at delivery and the composite fetal outcome. Psychosocial outcomes were also not significantly different between the remote blood pressure monitoring and usual care groups. Postpartum remote blood pressure monitoring in women with an established hypertensive disorder of pregnancy led to greater compliance with blood pressure follow‐up within 10 days, with no increase in unscheduled hypertension‐related presentations, postpartum readmissions or outpatient antihypertensive prescription.ConclusionsUtilizing a model of remote blood pressure monitoring which incorporates organized review and management by clinicians, may reduce antenatal outpatient visits and admissions, without increasing adverse fetal and maternal outcomes, in pregnant women who require frequent monitoring of their blood pressure. In postpartum women with a hypertensive disorder of pregnancy, remote blood pressure monitoring can improve guideline recommended follow‐up within 10 days. However, the meta‐analysis was hampered by study heterogeneity and a paucity of high‐quality evidence. Further randomized controlled trials are needed to confirm the findings of this review and provide recommendations.

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Home blood‐pressure monitoring in a hypertensive pregnant population

Abstract: Objective

Cited by 66 publications

References 27 publications

Management of Hypertension in the Obese Pregnant Patient

Management of Hypertension in the Obese Pregnant Patient

Is home blood‐pressure monitoring in hypertensive disorders of pregnancy consistent with clinic recordings?

Remote blood pressure monitoring in women at risk of or with hypertensive disorders of pregnancy: A systematic review and meta‐analysis

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