Out-of-office blood pressure measurement for the diagnosis of hypertension in pregnancy: Survey of Canadian Obstetric Medicine and Maternal Fetal Medicine specialists

Abstract

Background Multiple hypertension guidelines recommend out-of-office measurements for the diagnosis of hypertension in non-pregnant adults, whereas pregnancy guidelines recommend in-office blood pressure measurements. The objective of our study was to determine how Canadian Obstetric Medicine and Maternal Fetal Medicine specialists measure blood pressure in pregnancy. Methods An email survey was sent to 69 Canadian Obstetric Medicine and Maternal Fetal Medicine specialists in academic centers across Canada to explore the practice patterns of blood pressure measurement in pregnant women. Results The response rate was 48%. The majority of respondents (63.6%) preferred office blood pressure measurement for diagnosing hypertension, but relied on home blood pressure readings for ongoing monitoring and management of hypertension during pregnancy (59.4%). The preferred method of out-of-office blood pressure measurement was home monitoring; 24-hour ambulatory blood pressure monitoring was not used due to limited availability and cost. Conclusions There is wide practice variation in methods of measuring blood pressure among Canadian specialists managing hypertension in pregnancy.

“You Probably Won’t Notice Any Symptoms”: Blood Pressure in Pregnancy—Discourses of Contested Expertise in an Era of Self-Care and Responsibilization

“…The potential for self-monitoring blood pressure in pregnancy to improve the detection and monitoring of hypertension in pregnancy is being explored ( Tucker et al, 2017 ). Although Canadians include self-monitoring in their antenatal guidelines, and home blood pressure readings are the preferred method for out-of-office measurement for Canadian obstetricians, this is not the case widely ( Tran et al, 2019 ). Up-to-date figures for how many women in the United Kingdom might be self-monitoring their blood pressure in pregnancy indicate that one in five pregnant women monitor their own blood pressure, and almost half of women with a diagnosis of hypertension self-monitor ( Tucker et al, 2021 ).…”

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

“…Furthermore, variation exists amongst different international guidelines. 7,10,11 Many physicians do not advocate home BP devices validated in pregnant woman, 12 do not recommend standardized monitoring schedules, 9 nor provide patient education on interpretation of home readings and when to seek help for abnormal BP values. 13 Use of HBPM to manage HDP is unclear as it has not been well studied in pregnancy.…”

“… 7 HBPM is also being increasingly advised for pregnant women who are at risk for HDP. 8 , 9 Currently, there are no clear consensus on out-of-office BP threshold (home and ambulatory BP) for diagnosis of hypertension, initiation of anti-hypertensive medication and target in pregnancy, both ante-partum and post-partum. Furthermore, variation exists amongst different international guidelines.…”

Home blood pressure monitoring in the diagnosis and treatment of hypertension in pregnancy: a systematic review and meta-analysis

“…6 For these reasons, hypertension guidelines in Canada and internationally have strongly endorsed home blood pressure monitoring. [1][2][3][4][5] Canadian obstetricians, family physicians, and obstetric internal medicine and maternalfetal medicine specialists frequently recommend home monitoring to their pregnant patients 7,8 as a way to monitor for the development of hypertensive disorders of pregnancy. 9 However, there is wide variation in how clinicians recommend home blood pressure monitoring in pregnancy, which highlights a lack of relevant studies.…”

“…9 However, there is wide variation in how clinicians recommend home blood pressure monitoring in pregnancy, which highlights a lack of relevant studies. 8 Despite the widespread use of home blood pressure monitoring in pregnancy, the best way to measure blood pressure at home, the thresholds at which to initiate antihypertensive medications and treatment targets are unclear. Extrapolating the experience of home monitoring from the general population is problematic because hemodynamic changes of pregnancy can lead to reductions in blood pressure at 18 to 24 weeks.…”