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When compared to standard antihypertensive management, a remote telemonitoring program, guided by physicians, can significantly improve postnatal blood pressure control in females having a history of hypertensive pregnancy.
Physician-guided self-management of postnatal blood pressure in outpatient settings after hypertensive pregnancy led to a notable 6/5 mm Hg lower ambulatory blood pressure at 9 months postpartum, as elucidated from a recent randomized, blinded, open-label, end point trial. Researchers sought to assess whether an intervention aimed at improving blood pressure control during the postnatal period is linked to lower blood pressure levels compared to standard outpatient care in the initial 9 months postpartum.
Participants eligible for the study were >18 years of age and had experienced a pregnancy complicated by preeclampsia or gestational hypertension, necessitating postnatal antihypertensive medication upon discharge. They were randomly allocated in a 1:1 ratio to either self-monitoring with physician-optimized antihypertensive titration or standard postnatal care. The monitoring period extended for around 9 months, focusing on the key result of the 24-hour average diastolic blood pressure during the ninth month after childbirth, while accounting for the initial postnatal blood pressure levels.
In total, 220 volunteers were randomized to either intervention (n = 112) or control group (n = 108). Participants, averaging 32.6 (5.0) [mean (standard deviation)] years, included 40% with gestational hypertension and 60% with preeclampsia. The primary analysis involved 200 participants (91%). At 249 (16) days postpartum, the intervention group exhibited a 5.8 mm Hg lower 24-hour mean (standard deviation [SD]) diastolic blood pressure (71.2 [5.6] mm Hg) compared to control group (76.6 [5.7] mm Hg).
Similarly, the intervention group exhibited a 6.5 mm Hg reduction in the 24-hour average (SD) systolic blood pressure, registering at 114.0 (7.7) mm Hg, in contrast to the control group, which recorded 120.3 (9.1) mm Hg. In summary, the implementation of self-monitoring and physician-guided adjustment of antihypertensive medications in hypertensive pregnant women emerges as a promising strategy for achieving lower postpartum blood pressure levels during the critical first 9 months, surpassing the outcomes of conventional postnatal outpatient care.
JAMA
Long-Term Blood Pressure Control After Hypertensive Pregnancy Following Physician-Optimized Self-Management The POP-HT Randomized Clinical Trial
Jamie Kitt et al.
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