Effect of Self-monitoring of Blood Pressure on Diagnosis of Hypertension During Higher-Risk Pregnancy
Authors: Katherine L. Tucker, Sam Mort, Ly-Mee Yu, Helen Campbell, Oliver Rivero-Arias, Hannah M. Wilson, Julie Allen, Rebecca Band, Alison Chisholm, Carole Crawford, Greig Dougall, Lazarina Engonidou, Marloes Franssen, Marcus Green, Sheila Greenfield, Lisa Hinton, James Hodgkinson, Layla Lavallee, Paul Leeson, Christine McCourt, Lucy Mackillop, Jane Sandall, Mauro Santos, Lionel Tarassenko, Carmelo Velardo, Lucy Yardley, Lucy C. Chappell, Richard J. McManus, Johanna Cook, Maria Coates, Thomas Gabriel, Stephanie Brann, Joris De Henau, Sadie Kelly, Dave Watt, David Judge, Luis Castello, Tabitha Wishlade, Helen Price, Eleni Fotaki, Zoe Vowles, Alice Lewin, Hayley Tarft, Julie Wade, Declan Symington, Jessamine Hunt, Maria Slaney, Charlotte Mungeam, Rehan Khan, Amy Thomas, Tabitha Newman, Melanie Gouldbourne, Alexandra Keen, Alice Rossi, Zandile Maseko, David Churchill, Laura Devison, Kayleigh Brooks, Julia Icke, Patrick Bose, Fidelma Lee, Suzanne Scanlon, Joanna Girling, Mark Johnson, Natasha Singh, Carmela Martella, Christine Adamson, Maria Sogo Buaki, Nikki Beadle, Harriet Hickey, Amanda Iriondo-Coysh, Joanna Chilvers, Daisy Duncan, Miriam Bourke, Jenny Myers, Natalie Barry, Heather Glossop, Kimberley Farrant, Clare Waters, Sujatha Thamban, Prudence Jones, Sophia Felippe, Nick Kametas, Polly Kay, Katherine Clark, Rebecca Jarman, Olivia Snowball, Hayley Martin, Osaeloke Osakwe, Bernadette Tilley, Any Barker, Raquel Gonzalez, Asma Khalil, Sophie Robinson, Lisa Canclini, Rebecca Unwin, Katie Morris, Dianne Mellers, Phern Adams, Lesley Brittain, Sohpie Dann, Chloe O'Hara, Diane Whitehouse, Bini Ajay, Geraldine Upson, Hannah O'Donnell, Maria Zammit-Mangion, Julie Tebbutt, Lisa Frankland, Danielle Thornton, Kristina Sexton, Rebecca Crowe, Amy Bowers, Joanne Winterbottom
Journal: JAMA (2022)

<h3>Importance</h3> Inadequate management of elevated blood pressure (BP) is a significant contributing factor to maternal deaths. Self-monitoring of BP in the general population has been shown to improve the diagnosis and management of hypertension; however, little is known about its use in pregnancy. <h3>Objective</h3> To determine whether self-monitoring of BP in higher-risk pregnancies leads to earlier detection of pregnancy hypertension. <h3>Design, Setting, and Participants</h3> Unblinded, randomized clinical trial that included 2441 pregnant individuals at higher risk of preeclampsia and recruited at a mean of 20 weeks' gestation from 15 hospital maternity units in England between November 2018 and October 2019. Final follow-up was completed in April 2020. <h3>Interventions</h3> Participating individuals were randomized to either BP self-monitoring with telemonitoring (n = 1223) plus usual care or usual antenatal care alone (n = 1218) without access to telemonitored BP. <h3>Main Outcomes and Measures</h3> The primary outcome was time to first recorded hypertension measured by a health care professional. <h3>Results</h3> Among 2441 participants who were randomized (mean [SD] age, 33 [5.6] years; mean gestation, 20 [1.6] weeks), 2346 (96%) completed the trial. The time from randomization to clinic recording of hypertension was not significantly different between individuals in the self-monitoring group (mean [SD], 104.3 [32.6] days) vs in the usual care group (mean [SD], 106.2 [32.0] days) (mean difference, −1.6 days [95% CI, −8.1 to 4.9];<i>P</i> = .64). Eighteen serious adverse events were reported during the trial with none judged as related to the intervention (12 [1%] in the self-monitoring group vs 6 [0.5%] in the usual care group). <h3>Conclusions and Relevance</h3> Among pregnant individuals at higher risk of preeclampsia, blood pressure self-monitoring with telemonitoring, compared with usual care, did not lead to significantly earlier clinic-based detection of hypertension. <h3>Trial Registration</h3> ClinicalTrials.gov Identifier:NCT03334149