Abstract EP50: Implementation Of A Cloud-Connected Remote Blood Pressure Monitoring Program During The Postpartum Period Improves Ascertainment

Abstract

Introduction: Postpartum hypertension is a leading cause of postpartum hospital readmissions and severe maternal morbidity. Monitoring postpartum blood pressure (BP) through office visits is challenging due to barriers in accessing care, which disproportionately affect people of color. Remote BP monitoring programs are promising but many require cellular data plans or smartphones. The aim of this study is to examine the impact of a cloud-connected remote BP monitoring program in BP ascertainment during the six weeks postpartum in a diverse, safety-net hospital population. Methods: Eligible patients were those delivering between April 2020 through September 2021 at Boston Medical Center and at high-risk of postpartum hypertension, including those with hypertensive disorders of pregnancy, chronic hypertension, or hypertension during hospitalization for delivery. Patients were given a cell-enabled cuff and provided instructions in either English, Spanish, or Haitian Creole to take their BP daily for six weeks. BP measurements are transmitted to a web-based portal via the local cellular network. Data collected through the portal were merged with clinical information from the medical record. Metrics of compliance included frequency, defined as number of daily measurements ascertained, and duration, or day of last measurement, within the six-week period were examined using means and standard deviations (SD). We examined compliance by self-reported race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic). We calculated the prevalence of postpartum hypertension, defined as ≥ 2 BP measures with systolic blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood pressure (DBP) ≥90 mmHg. Severe hypertension was defined as SBP ≥160 and/or DPB ≥110. Results: Among the 3,525 deliveries during the study period, 1,008 (28.6%) were eligible for the program. Of the eligible participants, 40.5% identified as Black (n=409), 36.3% as Hispanic (n=366), and 14.4% as White (n=145). Participation was high; only 15 patients (1.5%) did not take any BP measures. Among the 993 participants, the average number of daily BP measures was 17.1 (SD: 10.4), which was similar across racial/ethnic groups (Black: 17.3, Hispanic: 16.5, White: 17.1). Furthermore, the mean duration of participation was 31.7 days (SD: 12.2), which was also similar by race/ethnicity. In this high-risk cohort, the prevalence of postpartum hypertension was 64.3% (n=638), with 9.6% (n=61) meeting severe criteria. Conclusion: In conclusion, implementation of a cloud-connected BP monitoring program among a diverse, safety-net population was successful at ascertaining multiple BP measures in the postpartum period. Furthermore, similar patterns of use across racial and ethnic groups suggest that this program could reduce disparities with respect to postpartum BP ascertainment.