A virtual blood pressure (BP) monitoring intervention for postpartum patients with hypertensive disorders of pregnancy resulted in a 93% reduction in hospital readmissions. The study utilized home BP monitoring and medication titration to maintain healthy BP levels. Compared to a historical reference group, the intervention led to higher rates of achieving a healthy BP and lower readmission rates. However, limitations included small sample size and incomplete participation, highlighting the need for improved engagement among diverse populations. Virtual care is increasingly being utilized to support postpartum women.
A virtual intervention utilizing blood pressure (BP) monitoring has shown promising results in preventing hospital readmissions among patients with hypertensive disorders of pregnancy, achieving a remarkable 93 percent avoidance rate.
Hypertensive disorders of pregnancy (HDP) pose a significant health risk, with the Centers for Disease Control and Prevention (CDC) reporting a rise in the occurrence of these conditions from 13.3 percent to 15.9 percent between 2017 and 2019. Moreover, they are identified as a leading cause of pregnancy-related deaths in the United States.
Given the increasing availability of virtual healthcare resources, researchers sought to investigate the effectiveness of home BP monitoring in treating HDP patients, with the primary aim of achieving a healthy systolic blood pressure (SBP) level of 130/80 mm Hg or lower within six weeks postpartum.
The study included 62 postpartum patients who had recently delivered at Massachusetts General Hospital between February and May 2021. Among them, 23 percent had chronic hypertension (cHTN), 45 percent had gestational hypertension (TN), and 31 percent had preeclampsia. Data from a historical reference group comprising 79 HDP patients from 2020 were also utilized for comparison.
All participants were equipped with a BP cuff or provided with one for the study, along with comprehensive education on BP measurement, hypertension, and HDP. Self-measured BP readings were collected from the participants, which guided medication initiation or titration. A study algorithm was employed to make subjective decisions, aiming to achieve a BP below 130/80 mm Hg within six weeks postpartum. The primary outcome was defined as hospital readmission within these six weeks, while secondary outcomes included BP measurements during the same period and the frequency of medication titration.
Half of the patients with chronic hypertension and preeclampsia were prescribed antihypertensive medication, along with 10 percent of those with gestational hypertension.
Among the 42 patients who completed the full duration of the intervention, only 7 percent were readmitted for hypertension, and all readmissions occurred within the first week following discharge. This readmission rate was lower compared to the historical cohort, which reported a 10 percent readmission rate.
Furthermore, the home-based BP monitoring intervention yielded better rates of achieving healthy blood pressure levels compared to the historical cohort. Within six weeks, 95 percent of study participants achieved an SBP below 130/80 mm Hg, while this figure was only 78 percent in the historical cohort. It is worth noting that 31 percent of patients remained on antihypertensive medication at the six-week postpartum mark.
While the study demonstrated a high success rate despite the initiation and titration of medication for many participants, there were limitations associated with the small study population and incomplete participation, highlighting the need to improve engagement among diverse populations.
As efforts to support postpartum women expand, virtual care plays an increasingly significant role. For instance, the state of Michigan introduced the Philips Pregnancy+ mobile application to Medicaid-eligible families, aiming to provide personalized support throughout pregnancy and the postpartum period. The app offers information on fetal growth, recommended content, tools, and health department programs tailored to each stage of pregnancy and postpartum journey.
