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 11 publications

(15 citation statements)

References 47 publications

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“…The difference in SBP between the two arms was more modest (−1.0 mmHg; −6.3, 4.4) [50,51]. Results of the subsequent main trial (POP-HT) that is powered to detect differences in 24-hour average ambulatory diastolic blood pressure at 6-9 months post-partum, with secondary outcomes including multimodal cardiovascular assessments (CMR and echocardiography), parameters derived from multiorgan MRI including brain and kidneys, and peripheral macrovascular and microvascular measures are expected to be published in the near future [52].…”

Section: Preventative Treatment Following a Placental Syndromementioning

confidence: 99%

Placental syndromes and long-term risk of hypertension

Fraser

Catov

2023

J Hum Hypertens

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Higher blood pressure prior to pregnancy is associated with increased risk of placental abruption, hypertension and preeclampsia, preterm delivery and fetal growth restriction. These conditions are jointly termed placental syndromes as they are characterised by impaired placentation and early placental vascularization. Placental syndromes are associated with an increased maternal risk of progression to hypertension and cardiovascular disease (CVD) in later life. Women affected by both a clinical placental syndrome and with evidence of placental maternal vascular malperfusion (MVM) have a particularly high risk of hypertension and CVD. Yet whether placental impairment and clinical syndromes are causes or consequences of higher blood pressure in women remains unclear. In this review, we address the relationship between blood pressure and maternal health in pregnancy. We conclude that there is a pressing need for studies with a range of detailed measures of cardiac and vascular structure and function taken before, during and after pregnancy to solve the ‘chicken and egg’ puzzle of women’s blood pressure and pregnancy health, and to inform effective precision medicine prevention and treatment of both placental syndromes and chronic hypertension in women.

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Section: Preventative Treatment Following a Placental Syndromementioning

confidence: 99%

Placental syndromes and long-term risk of hypertension

Fraser

Catov

2023

J Hum Hypertens

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

Cited by 11 publications

References 47 publications

Placental syndromes and long-term risk of hypertension

Placental syndromes and long-term risk of hypertension

Postpartum Home Blood Pressure Monitoring

Peripartum and Long-Term Maternal Cardiovascular Health After Preeclampsia

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