Postpartum blood pressure self-management following hypertensive pregnancy: protocol of the Physician Optimised Post-partum Hypertension Treatment (POP-HT) trial

McManus, Richard J; Mackillop, Lucy; Raman, Betty; Tunnicliffe, Elizabeth M; Román, Cristian; Santos, Mauro; Tucker, Katherine L.; Leeson, Paul; Chappell, Lucy C; Mollison, Jill; Khan, Maryam; Hanssen, Henner; Lewandowski, Adam J.; Aye, Christina; Kenworthy, Yvonne; Kitt, Jamie; Mills, Rebecca; Thilaganathan, B.; Woodward, William E.; Frost, Annabelle; Suriano, Katie; McCourt, Annabelle; Tan, Cheryl; Lapidaire, Winok; Cairns, A

doi:10.1136/bmjopen-2021-051180

Cited by 12 publications

(18 citation statements)

References 47 publications

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“…This was a single-center; 2-group; parallel, randomized, open, blinded end-point (PROBE) study. A protocol article detailed the study’s methods . All participants were recruited from the Women’s Centre at Oxford University Hospitals NHS Foundation Trust in the UK.…”

Section: Methodsmentioning

confidence: 99%

Long-Term Blood Pressure Control After Hypertensive Pregnancy Following Physician-Optimized Self-Management

Kitt,

Fox,

Frost

et al. 2023

JAMA

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ImportancePregnancy hypertension results in adverse cardiac remodeling and higher incidence of hypertension and cardiovascular diseases in later life.ObjectiveTo evaluate whether an intervention designed to achieve better blood pressure control in the postnatal period is associated with lower blood pressure than usual outpatient care during the first 9 months postpartum.Design, Setting, and ParticipantsRandomized, open-label, blinded, end point trial set in a single hospital in the UK. Eligible participants were aged 18 years or older, following pregnancy complicated by preeclampsia or gestational hypertension, requiring antihypertensive medication postnatally when discharged. The first enrollment occurred on February 21, 2020, and the last follow-up, November 2, 2021. The follow-up period was approximately 9 months.InterventionsParticipants were randomly assigned 1:1 to self-monitoring along with physician-optimized antihypertensive titration or usual postnatal care.Main Outcomes and MeasuresThe primary outcome was 24-hour mean diastolic blood pressure at 9 months postpartum, adjusted for baseline postnatal blood pressure.ResultsTwo hundred twenty participants were randomly assigned to either the intervention group (n = 112) or the control group (n = 108). The mean (SD) age of participants was 32.6 (5.0) years, 40% had gestational hypertension, and 60% had preeclampsia. Two hundred participants (91%) were included in the primary analysis. The 24-hour mean (SD) diastolic blood pressure, measured at 249 (16) days postpartum, was 5.8 mm Hg lower in the intervention group (71.2 [5.6] mm Hg) than in the control group (76.6 [5.7] mm Hg). The between-group difference was −5.80 mm Hg (95% CI, −7.40 to −4.20; P &lt; .001). Similarly, the 24-hour mean (SD) systolic blood pressure was 6.5 mm Hg lower in the intervention group (114.0 [7.7] mm Hg) than in the control group (120.3 [9.1] mm Hg). The between-group difference was −6.51 mm Hg (95% CI, −8.80 to −4.22; P &lt; .001).Conclusions and RelevanceIn this single-center trial, self-monitoring and physician-guided titration of antihypertensive medications was associated with lower blood pressure during the first 9 months postpartum than usual postnatal outpatient care in the UK.Trial RegistrationClinicalTrials.gov Identifier: NCT04273854

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Section: Methodsmentioning

confidence: 99%

Long-Term Blood Pressure Control After Hypertensive Pregnancy Following Physician-Optimized Self-Management

Kitt,

Fox,

Frost

et al. 2023

JAMA

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“…No action prompts an app notification to continue daily readings. 95 App indicates application; BP, blood pressure; DBP, diastolic BP; GP‚ general practitioner; HDP, hypertensive disorders of pregnancies; and SBP, systolic BP.…”

Section: Clinical Benefits Of Improved-bp Control During the Puerperiummentioning

confidence: 99%

“…Larger validation studies of BP self-management are ongoing at present with mechanistic evaluation of peripheral resistance, cardiac output and function at rest, and on exercise. 95 This will hopefully help us answer the question of what is the optimal treatment regime, but there is no doubt there is a role for self-monitoring, self-management, and ACE (angiotensin-converting enzyme) inhibitors in the future of postpartum BP treatment. 83,96,100…”

Section: Postpartum Monitoring and Managementmentioning

confidence: 99%

Peripartum and Long-Term Maternal Cardiovascular Health After Preeclampsia

et al. 2023

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There is widespread acceptance of the increased prevalence of cardiovascular disease occurring within 1 to 2 decades in women following a preeclamptic pregnancy. More recent evidence suggests that the deranged biochemical and echocardiographic findings in women do not resolve in the majority of preeclamptic women following giving birth. Many women continue to be hypertensive in the immediate postnatal period with some exhibiting occult signs of cardiac dysfunction. There is now promising evidence that with close monitoring and effective control of blood pressure control in the immediate postnatal period, women may have persistently lower blood pressures many years after stopping their medication. This review highlights the evidence that delivering effective medical care in the fourth trimester of pregnancy as a means of improving the long-term cardiovascular health of women after a preeclamptic birth.

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“…49 Notably, one trial found that home BP monitoring resulted in small, sustained reductions of diastolic BP up to 3-4 years postpartum. 26 If confirmed, 50 these findings suggest that better control of postpartum hypertension may potentially reduce longer-term cardiovascular risk.…”

Section: Discussionmentioning

confidence: 91%

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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Postpartum blood pressure self-management following hypertensive pregnancy: protocol of the Physician Optimised Post-partum Hypertension Treatment (POP-HT) trial

Cited by 12 publications

References 47 publications

Long-Term Blood Pressure Control After Hypertensive Pregnancy Following Physician-Optimized Self-Management

Long-Term Blood Pressure Control After Hypertensive Pregnancy Following Physician-Optimized Self-Management

Peripartum and Long-Term Maternal Cardiovascular Health After Preeclampsia

Postpartum Home Blood Pressure Monitoring

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