Implementation of a home blood pressure monitoring program for the management of hypertensive disorders of pregnancy, an observational study in British Columbia, Canada

Abstract

Background COVID-19 pandemic has influenced health care delivery. We conducted an observational study to understand how obstetric medicine (ObM) physicians utilized home blood pressure monitoring (HBPM) to manage hypertension in pregnancy. Methods Pregnant participants with risk factors or diagnosis of hypertensive disorders of pregnancy (HDP) were enrolled, May 2020–December 2021, and provided with validated home blood pressure (BP) monitor. ObM physicians completed questionnaires to elicit how home BP readings were interpreted to manage HDP. Results We enrolled 103 people: 44 antepartum patients (33.5 ± 5 years, gestational age of 24 ± 5 weeks); 59 postpartum patients (35 ± 6 years, enrolled 6 ± 4 days post-partum). ObM physicians used range of home BP readings (70%) for management of HDP. Conclusions HBPM to manage HDP is acceptable and can be used to manage hypertension during pregnancy. Further studies are needed to assess the generalizability of our findings and the safety of HBPM reliance alone in management of HDP.

Self-monitoring of blood pressure and telemonitoring for hypertensive pregnant women: A literature review

“…The majority of women found self-monitoring of blood pressure easy to implement (98%) (19). For treatment decisions, 72% of physicians used the range of results, 21% used the mean, and 16% the blood pressure measurements in the last three Remote monitoring adherence had a median value of 89.4% and the level of adherence was found to be associated with the Patient Health Questionnaire-9 (PHQ-9) and Experiences in Close Relationships-Revised Scale (ECR-R) results (20).…”

“…Both patients and doctors positively accepted home blood pressure monitoring (18). The implementation was considered easy (19). The acceptance of self-monitoring of blood pressure among pregnant women with gestational or chronic hypertension was determined based on adherence to blood pressure measurement (10).…”

“…However, repeated measurements in the clinic remain the priority for treatment decisions (14). In a pandemic context, a study by Tran et al (19) stated that the results of blood pressure self-monitoring alone were able for hypertension management and most doctors used the range of blood pressure results at home for the determination. However, this was different from the results of the Chappell et al study (13) which revealed no difference in antihypertensive medication since doctors preferred to rely on blood pressure results in the clinic even though there was access to the patient's self-monitoring data.…”