Abstract
BackgroundHypertensive disorders of pregnancy (HDP), such as preeclampsia (PE) or the Hemolysis Elevated Liver enzymes and Low Platelets (HELLP) syndrome are associated with elevated cardiovascular disease (CVD) risks, but standardized prevention guidelines after such pregnancies are lacking. Hypertension is the first emerging risk factor after PE/HELLP pregnancies and is a major risk factor for CVD. Hypertension before the age of 55 years may lead to various manifestations of end-organ damage at relatively young age. Therefore, timely treatment of elevated blood pressure is mandatory, but many of these high-risk women have long-term undetected and untreated hypertension before adequate treatment is initiated.AimThe aim of our study is to assess whether home blood pressure monitoring (HBPM) in women with a previous PE/HELLP pregnancy is a valuable tool for the early detection of hypertension.MethodsWomen with a history of both early and late PE/HELLP syndrome aged 40–60 years are invited to participate. Patients with a history of CVD, known hypertension and/or use of antihypertensive medication are excluded. Women are randomized between HPBM or ‘usual care’. The primary outcome is feasibility and usability of HBPM after 1 year of follow-up.Secondary outcomes will be the effectiveness of HPBM to detect hypertension, the efficacy of BP treatment, quality of life, health-related symptoms, work ability, and life-style behaviour.The results of this study will provide better strategies for timely detection and prevention of hypertension in women after PE/HELLP.Trial registrationClinicalTrials.gov, NCT03228082. Registered June 15, 2017.
Highlights
Hypertensive disorders of pregnancy (HDP), such as preeclampsia (PE) or the Hemolysis Elevated Liver enzymes and Low Platelets (HELLP) syndrome are associated with elevated cardiovascular disease (CVD) risks, but standardized prevention guidelines after such pregnancies are lacking
The aim of our study is to assess whether home blood pressure monitoring (HBPM) in women with a previous history of PE/HELLP is a valuable tool in clinical practice for early detection and timely treatment of hypertension
We aim to demonstrate that HBPM is an acceptable and easy way to check blood pressure regularly
Summary
Hypertensive disorders of pregnancy (HDP), such as preeclampsia (PE) or the Hemolysis Elevated Liver enzymes and Low Platelets (HELLP) syndrome are associated with elevated cardiovascular disease (CVD) risks, but standardized prevention guidelines after such pregnancies are lacking. Cardiovascular disease (CVD) is the leading cause of mortality in women worldwide. One of the major risk factors is high blood pressure [1]. Important female-specific risk factors for CVD are hypertensive disorders of pregnancy (HDP), which may induce earlier occurrence of high blood pressure [3]. HDP complicate 10–15% of all pregnancies [4, 5] This group consists of chronic hypertension, gestational or pregnancy-induced hypertension (PIH), preeclampsia (PE) and Hemolysis Elevated Liver enzymes Low Platelets (HELLP) syndrome. De novo hypertension during pregnancy is diagnosed when hypertension is present after 20 weeks of gestation
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