Evaluating the feasibility and impact of a remote, algorithm-based blood pressure titration program in postpartum...

Optimal postpartum management of hypertensive disorders of pregnancy (HDP) remains unknown. This pilot randomized control trial explored feasibility and safety of an algorithmic, text-based intervention targeting a blood pressure (BP) < 130/80 mmHg (in accordance with American College of Cardiology/American Heart Association recommendations - ACC/AHA) on hypertension management at 6 weeks postpartum as compared with routine care.

200 postpartum patients with HDP (excluding chronic hypertension) were randomized at hospital discharge for delivery or postpartum HDP admission from a tertiary care center in a 1:1 fashion to the intervention (targeting a blood pressure < 130/ 80 mmHg) or routine care. Patients and clinicians were blinded with respect to randomization.

The primary outcome was the proportion of patients who achieved normotension as defined by the ACC/AHA (systolic blood pressure < 130 mmHg). Secondary outcomes were frequency of medication titration, outpatient visits, and non-billable healthcare encounters.

The virtual intervention did not differ from routine care with respect to the primary outcome using office- ascertained BPs (72% intervention vs 74% routine care, p = 0.83). At 6 weeks postpartum, clinic systolic BP did not differ by group (121 mmHg vs 119 mmHg, p = 0.3), though home-reported SBPs during the same period were lower among those randomized to the intervention (119 mmHg vs 125 mmHg, p < 0.001). No adverse events occurred in either group.

As compared to routine care delivered at a tertiary care center, no differences were observed with respect to systolic BP at 6 weeks postpartum using a virtual, algorithm-based intervention. A high proportion of patients in both randomized groups achieving normotension by ACC/AHA targets without adverse events.