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Postpartum Home Blood Pressure Monitoring: A Systematic Review
Dale W Steele1, Gaelen P Adam, Ian J Saldanha
1Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, and the Department of Epidemiology, Brown University School of Public Health, and the Department of Emergency Medicine, the Department of Pediatrics, and Department of Medicine, and the Department of Obstetrics and Gynecology, Brown University Warren Alpert Medical School, Providence, Rhode Island; the Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; the Center for Outcomes Research and Evaluation, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; the Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; and the Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.
Objective:
To assess the effectiveness of postpartum home blood pressure (BP) monitoring compared with clinic-based follow-up and the comparative effectiveness of alternative home BP-monitoring regimens.
Data Sources:
Search of Medline, Cochrane, EMBASE, CINAHL, and ClinicalTrials.gov from inception to December 1, 2022, searching for home BP monitoring in postpartum individuals.
Methods Of Study Selection:
We included randomized controlled trials (RCTs), nonrandomized comparative studies, and single-arm studies that evaluated the effects of postpartum home BP monitoring (up to 1 year), with or without telemonitoring, on postpartum maternal and infant outcomes, health care utilization, and harm outcomes. After double screening, we extracted demographics and outcomes to SRDR+.
Tabulation, Integration, And Results:
Thirteen studies (three RCTs, two nonrandomized comparative studies, and eight single-arm studies) met eligibility criteria. All comparative studies enrolled participants with a diagnosis of hypertensive disorders of pregnancy. One RCT compared home BP monitoring with bidirectional text messaging with scheduled clinic-based BP visits, finding an increased likelihood that at least one BP measurement was ascertained during the first 10 days postpartum for participants in the home BP-monitoring arm (relative risk 2.11, 95% CI 1.68-2.65). One nonrandomized comparative study reported a similar effect (adjusted relative risk [aRR] 1.59, 95% CI 1.36-1.77). Home BP monitoring was not associated with the rate of BP treatment initiation (aRR 1.03, 95% CI 0.74-1.44) but was associated with reduced unplanned hypertension-related hospital admissions (aRR 0.12, 95% CI 0.01-0.96). Most patients (83.3-87.0%) were satisfied with management related to home BP monitoring. Home BP monitoring, compared with office-based follow-up, was associated with reduced racial disparities in BP ascertainment by approximately 50%.
Conclusion:
Home BP monitoring likely improves ascertainment of BP, which is necessary for early recognition of hypertension in postpartum individuals, and may compensate for racial disparities in office-based follow-up. There is insufficient evidence to conclude that home BP monitoring reduces severe maternal morbidity or mortality or reduces racial disparities in clinical outcomes.
Systematic Review Registration:
PROSPERO, CRD42022313075.
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Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
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01:21Sites for measruring blood pressure
The Brachial Artery: Primary Site for Blood Pressure Measurement