Compared with usual postnatal outpatient care in an open-label study at a single U.K. hospital, an innovative approach to hypertension management produced significantly lower blood pressure during the first 9 months postpartum. “Trial participants who self-monitored blood pressure with physician-guided titration of antihypertensive medications had significantly lower ambulatory blood pressure by 9 months postpartum, despite most participants no longer taking antihypertensive treatment,” conclude the authors.
Adult participants whose pregnancies were complicated by preeclampsia or gestational hypertension and who required postpartum antihypertensive medication were randomized to self-monitoring along with physician-optimized antihypertensive titration or usual postnatal care. Usual care typically consisted of a review at 7 to 10 days by a community midwife and a general practitioner visit at 6 to 8 weeks. The intervention group participants took daily blood pressure readings and used those to titrate their antihypertensive medications. Results were transmitted via a smartphone app to clinicians who could advise participants on changes in medications. The primary outcome was 24-hour mean diastolic blood pressure at 9 months postpartum.
“Two hundred twenty participants were randomly assigned to either the intervention group (n = 112) or the control group (n = 108),” the authors write. “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 < .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 < .001).”