INTRODUCTION:
The majority of hypertension-related postpartum morbidity occurs in the early postpartum period. Due to this, current guidelines recommend that patients with hypertensive disorders of pregnancy present for a blood pressure check within 7–10 days postpartum. However, in-office assessment of blood pressure has a relatively low adherence rate, and remote monitoring may be a safe and feasible alternative.
METHODS:
This was an institutional review board‒approved prospective multi-site randomized controlled trial of postpartum patients diagnosed with a hypertensive disorder of pregnancy prior to discharge between April 2021 and August 2021. Patients were randomized to either an in-office blood pressure check or remote monitoring through a web-enabled smartphone platform. The primary outcome was the rate of blood pressure ascertainment within 10 days of discharge. Secondary outcomes include rates of initiation of anti-hypertensive medication, readmission, and additional office/triage visits for hypertension.
RESULTS:
A total of 197 patients were randomized (101 in-office, 96 remote). Patients with remote monitoring had higher rates of postpartum blood pressure ascertainment compared to in-office surveillance (92.7% versus 59.0%, P<.001). However, patients in the remote monitoring group had additional unscheduled hypertension-related visits in the office or triage (21.7% versus 8.2%, P=.008), but there was no difference in readmission rate (4.4% versus 5.1%, P=.807) or rate of initiation of antihypertensives after discharge (9.8% versus 7.1%, P=.499).
CONCLUSION:
Remote monitoring can increase postpartum blood pressure ascertainment within 10 days of discharge for patients with hypertensive disorders of pregnancy. Additional research is needed to develop safe protocols that promote cost-effective health care utilization.
