Implementation of a universal postpartum blood pressure monitoring program: feasibility and outcomes

Hacker, Francis M.; Jeyabalan, Arun; Quinn, Beth; Hauspurg, Alisse

doi:10.1016/j.ajogmf.2022.100613

Cited by 15 publications

(20 citation statements)

References 20 publications

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“…Searches for the full review yielded 16,105 records, of which 380 were retrieved and screened in full text. Thirteen studies (in 18 articles [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] ) pertained to home BP monitoring: three RCTs, two nonrandomized comparative studies, and eight single-arm studies (see Fig. 1 for the literature flow diagram and Appendix 2, available online at http://links.lww.com/AOG/ D229, for design details).…”

Section: Resultsmentioning

confidence: 99%

“…The studies were published between 2017 and 2022 and included 3,867 participants. [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] Eleven studies were conducted in the United States, one was conducted in the United Kingdom, and one was conducted in India. The three RCTs had a total of 510 participants, the two nonrandomized comparative studies had 901 participants, and the eight single-arm studies had 2,456 participants.…”

Section: Resultsmentioning

confidence: 99%

“…Eight studies offered home BP monitoring to all individuals who met specific inclusion criteria (Table 2). 23,[27][28][29]35,36,38,40 Four of the studies described themselves as feasibility studies that assessed the practicality of home BP monitoring in a small group of participants (See Appendix 3, available online at http://links.lww.com/AOG/D229, for a detailed summary of these studies). 23,27,35,38 Among those who chose to participate in feasibility studies of home BP monitoring, 83.3-87.0% reported that they were satisfied with their postpartum care.…”

Section: Single-arm Studies Of Home Blood Pressure Monitoringmentioning

confidence: 99%

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Postpartum Home Blood Pressure Monitoring

Steele,

Adam,

Saldanha

et al. 2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: To assess the effectiveness of postpartum home blood pressure (BP) monitoring compared with clinic-based follow-up and the comparative effectiveness of alternative home BP–monitoring regimens. DATA SOURCES: Search of Medline, Cochrane, EMBASE, CINAHL, and ClinicalTrials.gov from inception to December 1, 2022, searching for home BP monitoring in postpartum individuals. METHODS OF STUDY SELECTION: We included randomized controlled trials (RCTs), nonrandomized comparative studies, and single-arm studies that evaluated the effects of postpartum home BP monitoring (up to 1 year), with or without telemonitoring, on postpartum maternal and infant outcomes, health care utilization, and harm outcomes. After double screening, we extracted demographics and outcomes to SRDR+. TABULATION, INTEGRATION, AND RESULTS: Thirteen studies (three RCTs, two nonrandomized comparative studies, and eight single-arm studies) met eligibility criteria. All comparative studies enrolled participants with a diagnosis of hypertensive disorders of pregnancy. One RCT compared home BP monitoring with bidirectional text messaging with scheduled clinic-based BP visits, finding an increased likelihood that at least one BP measurement was ascertained during the first 10 days postpartum for participants in the home BP–monitoring arm (relative risk 2.11, 95% CI 1.68–2.65). One nonrandomized comparative study reported a similar effect (adjusted relative risk [aRR] 1.59, 95% CI 1.36–1.77). Home BP monitoring was not associated with the rate of BP treatment initiation (aRR 1.03, 95% CI 0.74–1.44) but was associated with reduced unplanned hypertension-related hospital admissions (aRR 0.12, 95% CI 0.01–0.96). Most patients (83.3–87.0%) were satisfied with management related to home BP monitoring. Home BP monitoring, compared with office-based follow-up, was associated with reduced racial disparities in BP ascertainment by approximately 50%. CONCLUSION: Home BP monitoring likely improves ascertainment of BP, which is necessary for early recognition of hypertension in postpartum individuals, and may compensate for racial disparities in office-based follow-up. There is insufficient evidence to conclude that home BP monitoring reduces severe maternal morbidity or mortality or reduces racial disparities in clinical outcomes. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42022313075.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Single-arm Studies Of Home Blood Pressure Monitoringmentioning

confidence: 99%

See 1 more Smart Citation

Postpartum Home Blood Pressure Monitoring

Steele,

Adam,

Saldanha

et al. 2023

Obstetrics &Amp; Gynecology

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“…These findings are generally consistent with previously published studies examining risk factors for new-onset postpartum hypertension and postpartum preeclampsia. 5,6,10,14,21,22 We also used a multifactor approach to address the potential of additive effects among patients with multiple risk factors which may be useful for identifying patients at the highest risk of dn-PPHTN. We omitted race and ethnicity as these should not be considered an inherent risk factor; at most, racial demographics reflect the role of structural racism rather than biology.…”

Section: Discussionmentioning

confidence: 99%

“…25 Another study examining a universal remote postpartum BP monitoring program, reported an 8% prevalence of dn-PPHTN at 1 week after hospital discharge. 6 The cardiovascular sequelae of hypertensive disorders of pregnancy has been well documented, including increased risk in chronic hypertension and coronary heart disease. 26,27 The long-term implications of dn-PPHTN are unknown but in the short-term more than half of postpartum readmissions for hypertension are among patients without a hypertensive disorder of pregnancy.…”

Section: Discussionmentioning

confidence: 99%

De Novo Postpartum Hypertension: Incidence and Risk Factors at a Safety-Net Hospital

2023

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Background: Postpartum hypertension can be persistent, following a pregnancy complicated by hypertension, or new onset (de novo), following a normotensive pregnancy. The aim of this study is to estimate the incidence and identify risk factors for de novo postpartum hypertension (dn-PPHTN) among a diverse safety-net hospital population. Methods: We conducted a retrospective cohort study of 3925 deliveries from 2016 to 2018. All blood pressure (BP) measures during pregnancy through 12 months postpartum were extracted from medical records. Patients with chronic hypertension or hypertensive disorders of pregnancy were excluded. dn-PPHTN was defined as 2 separate BP readings with systolic BP ≥140 mm Hg and diastolic BP ≥90 mm Hg at least 48 hours after delivery. Severe dn-PPHTN was defined as systolic BP ≥160 and diastolic BP ≥110. We examined risk factors individually and in combination and timing of diagnosis. Results: Among the 2465 patients without a history of hypertension, 12.1% (n=298) developed dn-PPHTN; 17.1% of whom had severe dn-PPHTN (n=51). Compared to those without dn-PPHTN; cases were more likely to be ≥35 years, delivered via cesarean, or be current or former smokers. Patients with all of these characteristics had a 29% risk of developing dn-PPHTN, which was elevated among non-Hispanic Black patients (36%). Approximately 22% of cases were diagnosed after 6 weeks postpartum. Conclusions: More than 1 in 10 patients with normotensive pregnancies experience dn-PPHTN in the year after delivery. Opportunities to monitor and manage patients at the highest risk of dn-PPHTN throughout the entire year postpartum could mitigate cardiovascular related maternal morbidity.

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