FEASIBILITY, ACCEPTANCE AND SAFETY OF A HOME BASED TELEMONITORING STRATEGY IN WOMEN WITH POSTPARTUM HYPERTENSION. INTERIM ANALYSIS OF THE SWISS REGISTER FOR WOMEN WITH PPHT

Abstract

Objective: Postpartum hypertension (PPHT) is elevated blood pressure that persists or develops after pregnancy. PPHT affects 10% of all pregnancies and is the most common cause for re-hospitalization. PPHT stems from hypertensive disorders of pregnancy (HDP) which include preexisting and gestational hypertension, preeclampsia (PE), and eclampsia. Although the National Institute for Health and Care Excellence suggests tight controls there is no global consensus. The aim of the current analysis was to determine the feasibility, acceptance, and safety of a home-based telemonitoring strategy in women with PPHT. Design and method: Enrollment began in June 2020 at the University Hospital Basel Maternity Ward and Hypertension Clinic. Those with preexisting hypertension, HDP, and de novo PPHT were enrolled. A nested substudy allowed the participants to choose either a home-based telemonitoring approach or standard of care. The telemonitoring strategy was defined as a smartphone application provided by the study team or a programmed spreadsheet to report blood pressure followed by telephone consultations. Standard of care was hospital-based visits after discharge. All participants were assessed three months postpartum with a standardized hospital visit including a 24-hour blood pressure measurement, blood, biomarker and urine analysis. Results: 112 participants were prospectively enrolled from Jun 2020. Mean age was 33.5 ± 5.1 years, 8.9% had preexisting hypertension, 26.8% gestational hypertension, 55.4% preeclampsia (PE) 0.9% eclampsia, 6.9% HELLP and 17.9% had de novo PPHT. Family history of cardiovascular disease was seen in 50%, 8.9% had a family history of PE, and 20.5% were high risk for PE. The most common type of delivery was C-Section (74%), mean hospital stay was 6 days (±2.88) and IUGR was seen in 75.9% of the newborn babies. 98% of participants choose a home-based strategy. At 3 months, 97.8% reported a feeling of safety with home-based telemonitoring and would use the same approach in the future. There were zero re-hospitalizations due to high blood pressure. Conclusions: This analysis demonstrated that a home-based telemonitoring plan is feasible, well-accepted, and safe in terms of re-hospitalizations or blood pressure complications. This is relevant for the direct postpartum period and even more pertinent during a pandemic.