Implementation of a text-based postpartum blood pressure monitoring program at 3 different academic sites

Janssen, Matthew K.; Demers, Samuel; Srinivas, Sindhu K.; Bailey, Stacy Cooper; Boggess, Kim; You, Whitney; Grobman, William A.; Hirshberg, Adi

doi:10.1016/j.ajogmf.2021.100446

Cited by 23 publications

(23 citation statements)

References 14 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%

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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%

Postpartum Home Blood Pressure Monitoring

Steele,

Adam,

Saldanha

et al. 2023

Obstetrics &Amp; Gynecology

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“…[13][14][15] Prior small, randomized trials have shown a reduction in hospital readmission and increased adherence to ACOG recommendations surrounding BP assessment in the postpartum period. 13,16,17 Even more notably, prior studies have also demonstrated a reduction in racial disparities in blood pressure measurement in the postpartum period. 18 Despite this, few institutions have implemented system-level remote monitoring programs in the postpartum period.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with postpartum initiation of anti-hypertensive medication after hospital discharge among individuals with hypertensive disorders of pregnancy in a remote monitoring program

Hauspurg

Venkatakrishnan

Collins³

et al. 2023

Preprint

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Importance Following a hypertensive disorder of pregnancy, hypertension can worsen in the postpartum period following hospital discharge. Risk factors for hypertension exacerbation and associated outcomes have not been well characterized. Objective We sought to identify risk factors and characterize outcomes for individuals requiring initiation of anti-hypertensive medication following hospital discharge postpartum through our hospital system’s remote blood pressure management program. Design We performed a cohort study of individuals delivered between 9/2019-6/2021 and enrolled in our remote blood pressure monitoring program, which utilizes standardized protocols for anti-hypertensive medication initiation postpartum. Setting Postpartum unit at a referral hospital Participants Population-based sample of individuals with a hypertensive disorder of pregnancy (HDP, preeclampsia or gestational hypertension) and no pre-pregnancy hypertension. Exposure Anti-hypertensive medication initiation timing: no anti-hypertensive medications, initiation prior to hospital discharge postpartum, and initiation after hospital discharge postpartum Main outcomes Postpartum readmission and emergency room visits Results Of 2,705 individuals in our cohort, 1,458 (54%) required no anti-hypertensive medications postpartum, 637 individuals (24%) were discharged on anti-hypertensive medications, and 610 (23%) required initiation of anti-hypertensive agents after discharge. Utilizing an inpatient threshold of ≥ 150/100 mmHg in line with current obstetric guidelines for medication initiation postpartum fails to identify 385 (63%) of individuals who required medication initiation after discharge. These individuals had higher home blood pressures, increased odds of Emergency Room visits [aOR 2.22 (95%CI 1.65–2.98)] and hospital readmissions postpartum [aOR 5.73 (95%CI 3.72–8.82)] compared with individuals discharged on no medications. Conclusions and Relevance Over 20% of individuals with hypertensive disorders of pregnancy required initiation of anti-hypertensive medications after hospital discharge. Current blood pressure guidelines for medication initiation fail to identify the majority of these individuals during delivery hospitalization. These data support the critical role of remote blood pressure monitoring programs and highlight the need for improved tools for risk stratification and liberalization of thresholds for medication initiation postpartum.

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“…105 Multiple studies have demonstrated the feasibility and efficacy of postpartum remote blood pressure monitoring for patients with HDP. 106–109…”

Section: Cvh Promotion In the Postpartum Period Fourth Trimestermentioning

confidence: 99%

“…105 Multiple studies have demonstrated the feasibility and efficacy of postpartum remote blood pressure monitoring for patients with HDP. [106][107][108][109] Following comprehensive fourth trimester care, it is essential that patients undergo transition to longitudinal preventive care. APOs are a recognized risk-enhancing factors, and as such should be incorporated into counseling in combination with traditional atherosclerotic CVD risk assessment.…”

Section: Cvh Promotion In the Postpartum Period Fourth Trimestermentioning

confidence: 99%

Pregnancy as an Early Cardiovascular Moment: Peripartum Cardiovascular Health

Khan

Cameron

Lindley

2023

Circulation Research

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Pregnancy is commonly referred to as a window into future CVH (cardiovascular health). During pregnancy, physiological adaptations occur to promote the optimal growth and development of the fetus. However, in approximately 20% of pregnant individuals, these perturbations result in cardiovascular and metabolic complications, which include hypertensive disorders of pregnancy, gestational diabetes, preterm birth, and small-for-gestational age infant. The biological processes that lead to adverse pregnancy outcomes begin before pregnancy with higher risk of adverse pregnancy outcomes observed among those with poor prepregnancy CVH. Individuals who experience adverse pregnancy outcomes are also at higher risk of subsequent development of cardiovascular disease, which is largely explained by the interim development of traditional risk factors, such as hypertension and diabetes. Therefore, the peripartum period, which includes the period before (prepregnancy), during, and after pregnancy (postpartum), represents an early cardiovascular moment or window of opportunity when CVH should be measured, monitored, and modified (if needed). However, it remains unclear whether adverse pregnancy outcomes reflect latent risk for cardiovascular disease that is unmasked in pregnancy or if adverse pregnancy outcomes are themselves an independent and causal risk factor for future cardiovascular disease. Understanding the pathophysiologic mechanisms and pathways linking prepregnancy CVH, adverse pregnancy outcomes, and cardiovascular disease are necessary to develop strategies tailored for each stage in the peripartum period. Emerging evidence suggests the utility of subclinical cardiovascular disease screening with biomarkers (eg, natriuretic peptides) or imaging (eg, computed tomography for coronary artery calcium or echocardiography for adverse cardiac remodeling) to identify risk-enriched postpartum populations and target for more intensive strategies with health behavior interventions or pharmacological treatments. However, evidence-based guidelines focused on adults with a history of adverse pregnancy outcomes are needed to prioritize the prevention of cardiovascular disease during the reproductive years and beyond.

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Implementation of a text-based postpartum blood pressure monitoring program at 3 different academic sites

Cited by 23 publications

References 14 publications

Postpartum Home Blood Pressure Monitoring

Postpartum Home Blood Pressure Monitoring

Factors associated with postpartum initiation of anti-hypertensive medication after hospital discharge among individuals with hypertensive disorders of pregnancy in a remote monitoring program

Pregnancy as an Early Cardiovascular Moment: Peripartum Cardiovascular Health

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