Adherence with blood pressure self-monitoring in women with pregnancy hypertension, and comparisons to clinic readings: A secondary analysis of OPTIMUM-BP.

Liza Bowen,Lucy C Chappell,Louise Pealing,Katherine Tucker,Richard J Mcmanus

doi:10.1016/j.preghy.2021.05.016

Liza Bowen, Lucy C Chappell + Show 3 more

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https://doi.org/10.1016/j.preghy.2021.05.016

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Abstract

To assess adherence to self-monitoring of blood pressure (SMBP), and differences between SMBP and clinic readings, in a self-monitoring intervention for managing pregnancy hypertension. OPTIMUM-BP was an unmasked randomised controlled clinical trial. 154 women with pregnancy hypertension from four maternity units in England were recruited and randomised to SMBP or usual care. This secondary analysis included 91 women randomised to self-monitoring who provided BP readings. Trial instructions were for daily SMBP. Adherence was calculated as proportion of days on which SMBP readings were taken. Proportion of weeks in which at least 4 and at least 2 SMBP readings were taken was also calculated. Mean differences between clinic and SMBP measurements were calculated. Self-monitored BP data were available for 49 women with chronic hypertension and 42 women with gestational hypertension. Median percentage of days with SMBP readings was 77% (IQR 51, 89) in the chronic hypertension group and 85% (IQR 52, 95) in the gestational hypertension group. Adherence did not vary by different socio-demographic groups. Mean difference (95% CI) between clinic and SMBP for systolic BP was 0.99mmHg (-1.44, 3.41; chronic hypertension) and 3.76mmHg (0.75, 6.78; gestational hypertension) and for diastolic BP was 3.03mmHg (0.93, 5.12; chronic hypertension) and 3.27mmHg (0.56, 5.98; gestational hypertension). Adherence to self-monitoring was good and differences between SMBP and clinic readings were small. These findings offer reassurance about the use of self-monitoring at a time when it is being increasingly implemented in maternity settings.

Highlights

Hypertension affects around 10% of pregnancies and is associated with adverse maternal and fetal outcomes [1,2,3]
Of the 154 women randomised in the OPTIMUM-blood pressure (BP) study, 55 women with chronic hypertension and 49 women with gestational hy pertension were randomised to self-monitoring
Of the 49 women with gestational hypertension randomised to self-monitoring, 7 did not provide any self-monitoring of blood pressure (SMBP) data, leaving 42 (86%) women included in this analysis (Fig. 1)

Summary

Introduction

Hypertension affects around 10% of pregnancies and is associated with adverse maternal and fetal outcomes [1,2,3]. Other possible benefits of self-monitoring include a poten tial reduction in the need for clinic visits, reducing healthcare expense as well as being more convenient for women [4,5]. Studies in the nonpregnant population have shown that self-monitoring of blood pressure (SMBP) combined with self-titration of medication can be effective and lead to better blood pressure control than relying on clinic visits [6,7,8]. There is limited information on feasibility, adherence and outcomes of SMBP in the pregnant population which perhaps leads to reluctance of clinicians to trust women to monitor sufficiently or effectively [5,10]. There is insufficient evidence to date on whether there should

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