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Newman N, Beyuo TK, Nartey BA, Segbedzi-Rich E, Pangori A, Moyer CA, Lori JR, Oppong SA, Lawrence ER. Facilitators and barriers to home blood pressure monitoring among pregnant women in Ghana: a mixed-methods analysis of patient perspectives. BMC Pregnancy Childbirth 2024; 24:208. [PMID: 38504214 PMCID: PMC10949704 DOI: 10.1186/s12884-024-06421-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 03/13/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND The benefit of home blood pressure monitoring during pregnancy and in low-resource settings is incompletely understood. The objective of this study was to explore the experiences, barriers, and facilitators of home blood pressure monitoring among pregnant women in Ghana. METHODS This concurrent triangulation mixed-methods study was conducted at an urban tertiary hospital in Ghana. Participants were recruited from adult pregnant women presenting for routine antenatal care. Upon enrollment, participants' demographics and history were collected. At the next study visit, participants received audiovisual and hands-on training on using an automatic blood pressure monitor; they then monitored and logged their blood pressure daily at home for 2-4 weeks. At the final study visit, verbally administered surveys and semi-structured interviews assessed participant's experiences. Quantitative data were analyzed using R version 4.2.2, and frequencies and descriptive statistics were calculated. Qualitative data were imported into DeDoose 9.0.78 for thematic analysis. RESULTS Of 235 enrolled participants, 194 completed surveys; of those, 33 completed in-depth interviews. Participants' mean age was 31.6 (SD 5.3) years, 32.1% had not previously given birth, and 31.1% had less than a senior high school education. On a 4-point Likert scale, the majority reported they "definitely" were able to remember (n = 134, 69.1%), could find the time (n = 124, 63.9%), had the energy (n = 157, 80.9%), could use the blood pressure monitor without problems (n = 155, 79.9%), and had family approval (n = 182, 96.3%) while engaging in home blood pressure monitoring. 95.88% (n = 186) believed that pregnant women in Ghana should monitor their blood pressure at home. Qualitative thematic analysis demonstrated that most participants liked home blood pressure monitoring because of increased knowledge of their health during pregnancy. While most participants found measuring their blood pressure at home doable, many faced challenges. Participants' experiences with five key factors influenced how easy or difficult their experience was: 1) Time, stress, and daily responsibilities; 2) Perceived importance of BP in pregnancy; 3) Role of family; 4) Capability of performing monitoring; 5) Convenience of monitoring. CONCLUSIONS Among pregnant women in urban Ghana, home blood pressure monitoring was perceived as positive, important, and doable; however, challenges must be addressed.
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Affiliation(s)
- Noah Newman
- University of Michigan Medical School, 1301 Catherine St., Ann Arbor, MI, 48109, USA
| | - Titus K Beyuo
- University of Ghana Medical School, P.O. Box 4236, Korle Bu, Accra, Ghana.
- Korle Bu Teaching Hospital, Department of Obstetrics and Gynecology, University of Ghana Medical School, P.O. Box KB 77, Korle Bu, Accra, Ghana.
| | - Betty A Nartey
- Korle Bu Teaching Hospital, Department of Obstetrics and Gynecology, University of Ghana Medical School, P.O. Box KB 77, Korle Bu, Accra, Ghana
| | - Elorm Segbedzi-Rich
- Korle Bu Teaching Hospital, Department of Obstetrics and Gynecology, University of Ghana Medical School, P.O. Box KB 77, Korle Bu, Accra, Ghana
| | - Andrea Pangori
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Cheryl A Moyer
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
- Department of Learning Health Sciences, University of Michigan, 1111 E. Catherine Street, Ann Arbor, MI, 48109, USA
| | - Jody R Lori
- University of Michigan School of Nursing, 400 N Ingalls St, Ann Arbor, MI, 48104, USA
| | - Samuel A Oppong
- University of Ghana Medical School, P.O. Box 4236, Korle Bu, Accra, Ghana
- Korle Bu Teaching Hospital, Department of Obstetrics and Gynecology, University of Ghana Medical School, P.O. Box KB 77, Korle Bu, Accra, Ghana
| | - Emma R Lawrence
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
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Tran KC, Freiman S, Chaworth-Musters T, Purkiss S, Foster C, Khan NA, Chan WS. Implementation of a home blood pressure monitoring program for the management of hypertensive disorders of pregnancy, an observational study in British Columbia, Canada. Obstet Med 2024; 17:22-27. [PMID: 38660327 PMCID: PMC11037197 DOI: 10.1177/1753495x231172050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/09/2023] [Indexed: 04/26/2024] Open
Abstract
Background COVID-19 pandemic has influenced health care delivery. We conducted an observational study to understand how obstetric medicine (ObM) physicians utilized home blood pressure monitoring (HBPM) to manage hypertension in pregnancy. Methods Pregnant participants with risk factors or diagnosis of hypertensive disorders of pregnancy (HDP) were enrolled, May 2020-December 2021, and provided with validated home blood pressure (BP) monitor. ObM physicians completed questionnaires to elicit how home BP readings were interpreted to manage HDP. Results We enrolled 103 people: 44 antepartum patients (33.5 ± 5 years, gestational age of 24 ± 5 weeks); 59 postpartum patients (35 ± 6 years, enrolled 6 ± 4 days post-partum). ObM physicians used range of home BP readings (70%) for management of HDP. Conclusions HBPM to manage HDP is acceptable and can be used to manage hypertension during pregnancy. Further studies are needed to assess the generalizability of our findings and the safety of HBPM reliance alone in management of HDP.
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Affiliation(s)
- Karen C Tran
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada
- Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Sabina Freiman
- Internal Medicine Residency Training Program, University of British Columbia, Vancouver, Canada
| | - Tessa Chaworth-Musters
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Susan Purkiss
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Colleen Foster
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Nadia A Khan
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada
- Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Wee Shian Chan
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada
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Lawrence ER, Beyuo TK, Newman N, Klutse MA, Asempa JK, Pangori A, Moyer CA, Lori JR, Oppong SA. Ability and accuracy of patient-performed blood pressure monitoring among pregnant women in urban Ghana. AJOG GLOBAL REPORTS 2023; 3:100243. [PMID: 37645652 PMCID: PMC10461245 DOI: 10.1016/j.xagr.2023.100243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Patient-performed blood pressure monitoring in pregnancy is rarely performed in low- and middle-income country settings, including Ghana. The clinical efficacy of home blood pressure monitoring relies on a pregnant patient being able to independently execute the correct steps to position and use a blood pressure monitor and to achieve accurate blood pressure measurements. OBJECTIVE This study aimed to (1) assess whether pregnant women can correctly use an automatic blood pressure monitor to check their blood pressure before and after a brief training and (2) determine whether blood pressure values measured by pregnant women using an automatic monitor are similar to values measured by a healthcare provider using a standard clinic monitor. STUDY DESIGN This was a cross-sectional study conducted at the Korle Bu Teaching Hospital, a tertiary hospital in Accra, Ghana. Participants were adult pregnant women presenting for their first prenatal care visit. Data collection was performed by 2 Ghanaian physicians. Information on demographics, obstetrical history, and past medical history was collected. A brief training was provided on the correct use of the blood pressure monitor, including a verbal script, annotated photographs, and a hands-on demonstration. Pre- and posttraining assessments using a 9-item checklist of correct preparation, position, and use of an automatic blood pressure monitor were performed. Following a modified British Hypertension Society protocol, a series of 4 blood pressure measurements were taken, alternating between provider performed using a clinic monitor and patient performed using an automatic monitor intended for individual use and validated in pregnancy. RESULTS Among 176 participants, the mean age was 31.5 years (±5.6), and 130 (73.9%) were multiparous. Regarding socioeconomic characteristics, 128 (72.7%) were married, 171 (97.2%) had public insurance, and 87 (49.7%) had completed ≤9 years of formal education. Regarding clinical blood pressure issues, 19 (10.9%) had a history of a hypertensive disorder in a previous pregnancy, and 6 (3.4%) had chronic hypertension. Before receiving any training, 21 participants (12.1%) performed all 9 steps correctly to prepare, position, and use the automatic blood pressure monitor. Comparing pretraining vs posttraining ability, statistically significant increases were seen in the correct performance of each step and the mean number of steps performed correctly (6.1±1.8 vs 9.0±0.2, respectively; P<.001) and proportion performing all 9 steps correctly (12.1% vs 96.6%, respectively; P<.001). The mean difference between doctor-performed and patient-performed blood pressure measurements was 5.6±4.8 mm Hg for systolic blood pressure values and 3.4±3.08 mm Hg for diastolic blood pressure values, with most differences within 5 mm Hg for both systolic blood pressure values (102/176 [58.0%]) and diastolic blood pressure values (141/176 [80.1%]). CONCLUSION After a brief training, pregnant women in Ghana demonstrated that they are able to use an automatic blood pressure monitor to check their blood pressure correctly and accurately.
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Affiliation(s)
- Emma R. Lawrence
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI (Dr Lawrence, Ms Pangori, and Dr Moyer)
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Korle Bu, Accra, Ghana (Drs Beyuo and Oppong)
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana (Drs Beyuo, Klutse, Asempa, and Oppong)
- University of Michigan Medical School, Ann Arbor, MI (Mr Newman)
- University of Michigan School of Nursing, Ann Arbor, MI (Dr Lori)
| | - Titus K. Beyuo
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI (Dr Lawrence, Ms Pangori, and Dr Moyer)
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Korle Bu, Accra, Ghana (Drs Beyuo and Oppong)
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana (Drs Beyuo, Klutse, Asempa, and Oppong)
- University of Michigan Medical School, Ann Arbor, MI (Mr Newman)
- University of Michigan School of Nursing, Ann Arbor, MI (Dr Lori)
| | - Noah Newman
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI (Dr Lawrence, Ms Pangori, and Dr Moyer)
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Korle Bu, Accra, Ghana (Drs Beyuo and Oppong)
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana (Drs Beyuo, Klutse, Asempa, and Oppong)
- University of Michigan Medical School, Ann Arbor, MI (Mr Newman)
- University of Michigan School of Nursing, Ann Arbor, MI (Dr Lori)
| | - Makafui Aku Klutse
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI (Dr Lawrence, Ms Pangori, and Dr Moyer)
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Korle Bu, Accra, Ghana (Drs Beyuo and Oppong)
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana (Drs Beyuo, Klutse, Asempa, and Oppong)
- University of Michigan Medical School, Ann Arbor, MI (Mr Newman)
- University of Michigan School of Nursing, Ann Arbor, MI (Dr Lori)
| | - Joshua Kafui Asempa
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI (Dr Lawrence, Ms Pangori, and Dr Moyer)
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Korle Bu, Accra, Ghana (Drs Beyuo and Oppong)
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana (Drs Beyuo, Klutse, Asempa, and Oppong)
- University of Michigan Medical School, Ann Arbor, MI (Mr Newman)
- University of Michigan School of Nursing, Ann Arbor, MI (Dr Lori)
| | - Andrea Pangori
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI (Dr Lawrence, Ms Pangori, and Dr Moyer)
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Korle Bu, Accra, Ghana (Drs Beyuo and Oppong)
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana (Drs Beyuo, Klutse, Asempa, and Oppong)
- University of Michigan Medical School, Ann Arbor, MI (Mr Newman)
- University of Michigan School of Nursing, Ann Arbor, MI (Dr Lori)
| | - Cheryl A. Moyer
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI (Dr Lawrence, Ms Pangori, and Dr Moyer)
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Korle Bu, Accra, Ghana (Drs Beyuo and Oppong)
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana (Drs Beyuo, Klutse, Asempa, and Oppong)
- University of Michigan Medical School, Ann Arbor, MI (Mr Newman)
- University of Michigan School of Nursing, Ann Arbor, MI (Dr Lori)
| | - Jody R. Lori
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI (Dr Lawrence, Ms Pangori, and Dr Moyer)
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Korle Bu, Accra, Ghana (Drs Beyuo and Oppong)
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana (Drs Beyuo, Klutse, Asempa, and Oppong)
- University of Michigan Medical School, Ann Arbor, MI (Mr Newman)
- University of Michigan School of Nursing, Ann Arbor, MI (Dr Lori)
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Abstract
Purpose of Review Patients remain at risk for persistent and de novo postpartum hypertension related to pregnancy. This review aims to summarize the current definitions, clinical practices, and novel systems innovations and therapies for postpartum hypertension. Recent Findings Recent changes to the definitions of hypertension outside of pregnancy have not yet impacted definitions or management of hypertensive disorders of pregnancy (HDP), though research examining the implications of these new definitions on risks of developing HDP and the resultant sequelae is ongoing. The administration of diuretics has been shown to reduce postpartum hypertension among women with HDP. Widespread implementation of telemedicine models and remote assessment of ambulatory blood pressures has increased data available on postpartum blood pressure trajectories, which may impact clinical management. Additionally, policy changes such as postpartum Medicaid extension and an increasing emphasis on building bridges to primary care in the postpartum period may improve long-term outcomes for women with postpartum hypertension. Prediction models utilizing machine learning are an area of ongoing research to assist with risk assessment in the postpartum period. Summary The clinical management of postpartum hypertension remains focused on blood pressure control and primary care transition for cardiovascular disease risk reduction. In recent years, systemic innovations have improved access through implementation of new care delivery models. However, the implications of changing definitions of hypertension outside of pregnancy, increased data assessing blood pressure trajectories in the postpartum period, and the creation of new risk prediction models utilizing machine learning remain areas of ongoing research.
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Johnson S, Gordijn S, Damhuis S, Ganzevoort W, Brown M, von Dadelszen P, Magee LA, Khalil A. Diagnosis and Monitoring of White Coat Hypertension in Pregnancy: an ISSHP Consensus Delphi Procedure. Hypertension 2022; 79:993-1005. [PMID: 35263999 DOI: 10.1161/hypertensionaha.121.18356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is no accepted definition or standardized monitoring for white coat hypertension in pregnancy. This Delphi procedure aimed to reach consensus on out-of-office blood pressure (BP) monitoring, and white coat hypertension diagnostic criteria and monitoring. METHOD Relevant international experts completed three rounds of a modified Delphi questionnaire. For each item, the predefined cutoff for group consensus was ≥70% agreement, with 60% to 70% considered to warrant reconsideration at the subsequent round, and <60% considered insufficient to warrant consideration. RESULTS Of 230 experts, 137 completed the first round and 114 (114/137, 83.2%) completed all three. For out-of-office BP monitoring, there was consensus that home BP monitoring (HBPM) should be chosen; instructions given, pairs of BP values taken, opportunity given for women to qualify values they do not regard as valid, and BP considered evaluated when ≥25% of values are above a cutoff. For HBPM, BP should be taken at least 2 to 3 d/wk, at minimum in the morning; however, many factors may affect frequency and timing. Experts endorsed a clinic BP <140/90 mm Hg as normal. While not reaching consensus, most agreed that HBPM values should be lower than clinic BP. Among those, HBPM <135/85 mm Hg was considered normal. There was consensus that white coat hypertension warrants: HBPM at least 1 d/wk before 20 weeks, 2 to 3 d/wk after 20 weeks or if persistent hypertension develops, and symptom monitoring (ie, headache, visual symptoms, and right upper quadrant/epigastric pain). CONCLUSIONS Consensus-based diagnostic criteria and monitoring strategies should inform clinical care and research, to facilitate evaluation of out-of-office BP monitoring on pregnancy outcomes.
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Affiliation(s)
- Sonia Johnson
- Barts and the London Medical School, Queen Mary University of London, United Kingdom (S.J.)
| | - Sanne Gordijn
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, the Netherlands (S.G., S.D.)
| | - Stefanie Damhuis
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, the Netherlands (S.G., S.D.)
| | - Wessel Ganzevoort
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands (W.G.)
| | - Mark Brown
- Department of Renal Medicine, St. George Hospital and University of New South Wales, Sydney, Australia (M.B.)
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, United Kingdom (P.v.D., L.A.M.)
| | - Laura A Magee
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, United Kingdom (P.v.D., L.A.M.)
| | - Asma Khalil
- Fetal Medicine Unit, St George's Hospital, St George's University of London, United Kingdom. (A.K.).,Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, United Kingdom. (A.K.)
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Magee LA, Khalil A, Kametas N, von Dadelszen P. Toward personalized management of chronic hypertension in pregnancy. Am J Obstet Gynecol 2022; 226:S1196-S1210. [PMID: 32687817 PMCID: PMC7367795 DOI: 10.1016/j.ajog.2020.07.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/27/2020] [Accepted: 07/15/2020] [Indexed: 12/15/2022]
Abstract
Chronic hypertension complicates 1% to 2% of pregnancies, and it is increasingly common. Women with chronic hypertension are an easily recognized group who are in touch with a wide variety of healthcare providers before, during, and after pregnancy, mandating that chronic hypertension in pregnancy be within the scope of many practitioners. We reviewed recent data on management to inform current care and future research. This study is a narrative review of published literature. Compared with normotensive women, women with chronic hypertension are at an increased risk of maternal and perinatal complications. Women with chronic hypertension who wish to be involved in their care can do by measuring blood pressure at home. Accurate devices for home blood pressure monitoring are now readily available. The diagnostic criteria for superimposed preeclampsia remain problematic because most guidelines continue to include deteriorating blood pressure control in the definition. It has not been established how angiogenic markers may aid in confirmation of the diagnosis of superimposed preeclampsia when suspected, over and above information provided by routinely available clinical data and laboratory results. Although chronic hypertension is a strong risk factor for preeclampsia, and aspirin decreases preeclampsia risk, the effectiveness specifically among women with chronic hypertension has been questioned. It is unclear whether calcium has an independent effect in preeclampsia prevention in such women. Treating hypertension with antihypertensive therapy halves the risk of progression to severe hypertension, thrombocytopenia, and elevated liver enzymes, but a reduction in preeclampsia or serious maternal complications has not been observed; however, the lack of evidence for the latter is possibly owing to few events. In addition, treating chronic hypertension neither reduces nor increases fetal or newborn death or morbidity, regardless of the gestational age at which the antihypertensive treatment is started. Antihypertensive agents are not teratogenic, but there may be an increase in malformations associated with chronic hypertension itself. At present, blood pressure treatment targets used in clinics are the same as those used at home, although blood pressure values tend to be inconsistently lower at home among women with hypertension. Although starting all women on the same antihypertensive medication is usually effective in reducing blood pressure, it remains unclear whether there is an optimal agent for such an approach or how best to use combinations of antihypertensive medications. An alternative approach is to individualize care, using maternal characteristics and blood pressure features beyond blood pressure level (eg, variability) that are of prognostic value. Outcomes may be improved by timed birth between 38 0/7 and 39 6/7 weeks' gestation based on observational literature; of note, confirmatory trial evidence is pending. Postnatal care is facilitated by the acceptability of most antihypertensives (including angiotensin-converting enzymes inhibitors) for use in breastfeeding. The evidence base to guide the care of pregnant women with chronic hypertension is growing and aligning with international guidelines. Addressing outstanding research questions would inform personalized care of chronic hypertension in pregnancy.
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Affiliation(s)
- Laura A Magee
- Department of Women and Children's Health, King's College London, London, United Kingdom.
| | - Asma Khalil
- Department of Obstetrics and Gynecology, St. George's, University of London, London, United Kingdom
| | - Nikos Kametas
- Harris Birthright Centre, King's College Hospital, London, United Kingdom
| | - Peter von Dadelszen
- Department of Women and Children's Health, King's College London, London, United Kingdom
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Changes to management of hypertension in pregnancy, and attitudes to self-management: An online survey of obstetricians, before and following the first wave of the COVID-19 pandemic. Pregnancy Hypertens 2021; 26:54-61. [PMID: 34508949 PMCID: PMC8425952 DOI: 10.1016/j.preghy.2021.08.117] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/18/2021] [Accepted: 08/30/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study aimed to understand the views and practice of obstetricians regarding self-monitoring for hypertensive disorders of pregnancy (blood pressure (BP) and proteinuria), the potential for self-management (including actions taken on self-monitored parameters) and to understand the impact of the COVID-19 pandemic on such views. DESIGN Cross-sectional online survey pre- and post- the first wave of the COVID-19 pandemic. SETTING AND SAMPLE UK obstetricians recruited via an online portal. METHODS A survey undertaken in two rounds: December 2019-January 2020 (pre-pandemic), and September-November 2020 (during pandemic) RESULTS: 251 responses were received across rounds one (150) and two (101). Most obstetricians considered that self-monitoring of BP and home urinalysis had a role in guiding clinical decisions and this increased significantly following the first wave of the COVID-19 pandemic (88%, (132/150) 95%CI: 83-93% first round vs 96% (95%CI: 92-94%), (97/101), second round; p = 0.039). Following the pandemic, nearly half were agreeable to women self-managing their hypertension by using their own readings to make a pre-agreed medication change themselves (47%, 47/101 (95%CI: 37-57%)). CONCLUSIONS A substantial majority of UK obstetricians considered that self-monitoring had a role in the management of pregnancy hypertension and this increased following the pandemic. Around half are now supportive of women having a wider role in self-management of hypertensive treatment. Maximising the potential of such changes in pregnancy hypertension management requires further work to understand how to fully integrate women's own measurements into clinical care.
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9
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Tran K, Padwal R, Khan N, Wright MD, Chan WS. Home blood pressure monitoring in the diagnosis and treatment of hypertension in pregnancy: a systematic review and meta-analysis. CMAJ Open 2021; 9:E642-E650. [PMID: 34131027 PMCID: PMC8248564 DOI: 10.9778/cmajo.20200099] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Home blood pressure monitoring is increasingly used for pregnant individuals; however, there are no guidelines on such monitoring in this population. We assessed current practices in the prescription and use of home blood pressure monitoring in pregnancy. METHODS We conducted a systematic review and meta-analysis of observational studies and randomized controlled trials (RCTs). We conducted a structured search through the MEDLINE (from 1946), Embase (from 1974) and CENTRAL (from 2018) databases up to Oct. 19, 2020. We included trials comparing office and home blood pressure monitoring in pregnant people. Outcomes included patient education, home blood pressure device, monitoring schedule, adherence, diagnostic thresholds for home blood pressure, and comparison between home and office measurements of blood pressure. RESULTS We included in our review 21 articles on 19 individual studies (1 RCT, 18 observational) that assessed home and office blood pressure in pregnant individuals (n = 2843). We observed variation in practice patterns in terms of how home monitoring was prescribed. Eight (42%) of the studies used validated home blood pressure devices. Across all studies, measurements were taken 3 to 36 times per week. Third-trimester home blood pressure corresponding to office blood pressure of 140/90 mm Hg after application of a conversion factor ranged from 118 to 143 mm Hg (systolic) and from 76 to 92 mm Hg (diastolic), depending on the patient population and methodology. Systolic and diastolic blood pressure values measured at home were lower than office values by 4 (95% confidence interval [CI] -6 to -3) mm Hg and 3 (95% CI -4 to -2) mm Hg, respectively. INTERPRETATION Many issues related to home blood pressure monitoring in pregnancy are currently unresolved, including technique, monitoring schedule and target values. Future studies should prioritize the use of validated home measuring devices and standardized measurement schedules and should establish treatment targets. PROSPERO REGISTRATION CRD42020147352.
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Affiliation(s)
- Karen Tran
- Division of General Internal Medicine (Tran, Khan, Chan), Department of Medicine, University of British Columbia; Centre for Health Evaluation and Outcome Sciences (Tran, Khan); and Apex Information (Wright), Vancouver, BC; Division of General Internal Medicine (Padwal), Department of Medicine, University of Alberta, Edmonton, Alta.
| | - Raj Padwal
- Division of General Internal Medicine (Tran, Khan, Chan), Department of Medicine, University of British Columbia; Centre for Health Evaluation and Outcome Sciences (Tran, Khan); and Apex Information (Wright), Vancouver, BC; Division of General Internal Medicine (Padwal), Department of Medicine, University of Alberta, Edmonton, Alta
| | - Nadia Khan
- Division of General Internal Medicine (Tran, Khan, Chan), Department of Medicine, University of British Columbia; Centre for Health Evaluation and Outcome Sciences (Tran, Khan); and Apex Information (Wright), Vancouver, BC; Division of General Internal Medicine (Padwal), Department of Medicine, University of Alberta, Edmonton, Alta
| | - Mary-Doug Wright
- Division of General Internal Medicine (Tran, Khan, Chan), Department of Medicine, University of British Columbia; Centre for Health Evaluation and Outcome Sciences (Tran, Khan); and Apex Information (Wright), Vancouver, BC; Division of General Internal Medicine (Padwal), Department of Medicine, University of Alberta, Edmonton, Alta
| | - Wee Shian Chan
- Division of General Internal Medicine (Tran, Khan, Chan), Department of Medicine, University of British Columbia; Centre for Health Evaluation and Outcome Sciences (Tran, Khan); and Apex Information (Wright), Vancouver, BC; Division of General Internal Medicine (Padwal), Department of Medicine, University of Alberta, Edmonton, Alta
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10
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Cheu LA, Drexler K, Kominiarek MA. Using m-Health apps to diagnose hypertension in pregnancy. Pregnancy Hypertens 2020; 22:99-100. [PMID: 32769046 DOI: 10.1016/j.preghy.2020.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/12/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Lindsay A Cheu
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology of Northwestern University, 250 E. Superior, Suite 05-2149, Prentice Women's Hospital Chicago, IL 60611, United States.
| | - Kathleen Drexler
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology of Northwestern University, 250 E. Superior, Suite 05-2149, Prentice Women's Hospital Chicago, IL 60611, United States
| | - Michelle A Kominiarek
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology of Northwestern University, 250 E. Superior, Suite 05-2149, Prentice Women's Hospital Chicago, IL 60611, United States
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Kalafat E, Benlioglu C, Thilaganathan B, Khalil A. Home blood pressure monitoring in the antenatal and postpartum period: A systematic review meta-analysis. Pregnancy Hypertens 2020; 19:44-51. [PMID: 31901652 DOI: 10.1016/j.preghy.2019.12.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/05/2019] [Indexed: 11/26/2022]
Abstract
Recent evidence suggests that home blood pressure monitoring (HBPM) is an effective way of managing women with hypertensive disorders of pregnancy (HDP) without increasing adverse outcomes. The aim of this systematic review and meta-analysis was to investigate the safety and efficacy of HBPM during pregnancy. Medline, EMBASE and the Cochrane library databases were searched electronically in November 2018. Studies were included from which data could be extracted on the pregnancy outcomes and included pregnancies with HDP or at increased risk of developing HDP. Data from nine studies were included in the meta-analysis. The use of HBPM during the antenatal period was associated with reduced risk of induction of labor (OR: 0.55, 95% CI: 0.36-0.82, 444 women, I2 = 0%), prenatal hospital admissions (OR: 0.31, 95% CI: 0.19-0.49, 416 women, I2 = 0%) and diagnosis of preeclampsia (OR: 0.50, 95% CI: 0.31-0.81, 725 women, I2 = 37%). The number of antenatal visits was significantly less in the HBPM group (standard mean difference: -0.49, 95% CI: -0.82 to -0.16, 738 women, I2 = 75%). There were no significant differences between HBPM and conventional care regarding composite maternal, fetal or neonatal outcomes when used during the antenatal period. There were no significant differences between the groups who had HBPM compared to those who had conventional care regarding postpartum readmissions and obtaining a blood pressure measurement within 10 days of delivery after discharge. The significant clinical heterogeneity and low quality of evidence are the main limitations, and therefore, more high quality studies are needed.
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Affiliation(s)
- Erkan Kalafat
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0RE, UK; Department of Statistics, Middle East Technical University, Ankara, Turkey
| | - Can Benlioglu
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0RE, UK; Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine, Ankara, TURKEY
| | - Basky Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0RE, UK; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London SW17 0RE, UK
| | - Asma Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0RE, UK; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London SW17 0RE, UK.
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Khalil A, Perry H, Lanssens D, Gyselaers W. Telemonitoring for hypertensive disease in pregnancy. Expert Rev Med Devices 2019; 16:653-661. [PMID: 31282755 DOI: 10.1080/17434440.2019.1640116] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Introduction: Telemonitoring of hypertension in pregnancy is becoming increasingly common. Several small studies have described the potential benefits of patient-led remote monitoring, including fewer hospital visits, better blood pressure control, and cost savings. Areas covered: This review summarises the principles of prenatal remote monitoring of hypertension as well as the types of devices and applications currently in use. We summarise current evidence regarding the potential benefits and pitfalls with respect to outcomes for mothers, neonates and wider population health. Core topics for ongoing and future research are discussed, with special emphasis on feasibility and validation of technologies, methodological standardization, patient safety, privacy and acceptability, and health economics and governance. Expert opinion: Telemonitoring of hypertension in pregnancy is likely to become commonplace in the next five to ten years and research now must be directed to ensure it is used in the safest way before its general introduction into daily clinical practice can be recommended. Raising women's awareness of their health condition could improve both pregnancy and long-term health outcomes.
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Affiliation(s)
- Asma Khalil
- a Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London , London , UK.,b Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust , London , UK
| | - Helen Perry
- a Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London , London , UK.,b Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust , London , UK
| | - Dorien Lanssens
- c Department of Physiology, Hasselt University, Hasselt, Belgium and Mobile Health Unit, Facultiy of Medicine and Life Sciences, Hasselt University , Hasselt , Belgium
| | - Wilfried Gyselaers
- d Department of Obstetrics, Ziekenhuis Oost-Limburg, Genk, Belgium and Department of Physiology, Hasselt University , Hasselt , Belgium
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Braunthal S, Brateanu A. Hypertension in pregnancy: Pathophysiology and treatment. SAGE Open Med 2019; 7:2050312119843700. [PMID: 31007914 PMCID: PMC6458675 DOI: 10.1177/2050312119843700] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/22/2019] [Indexed: 12/14/2022] Open
Abstract
Hypertensive disorders of pregnancy, an umbrella term that includes preexisting and gestational hypertension, preeclampsia, and eclampsia, complicate up to 10% of pregnancies and represent a significant cause of maternal and perinatal morbidity and mortality. Despite the differences in guidelines, there appears to be consensus that severe hypertension and non-severe hypertension with evidence of end-organ damage need to be controlled; yet the ideal target ranges below 160/110 mmHg remain a source of debate. This review outlines the definition, pathophysiology, goals of therapy, and treatment agents used in hypertensive disorders of pregnancy.
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Affiliation(s)
| | - Andrei Brateanu
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
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Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, Hall DR, Warren CE, Adoyi G, Ishaku S. Hypertensive Disorders of Pregnancy: ISSHP Classification, Diagnosis, and Management Recommendations for International Practice. Hypertension 2019; 72:24-43. [PMID: 29899139 DOI: 10.1161/hypertensionaha.117.10803] [Citation(s) in RCA: 1119] [Impact Index Per Article: 223.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Mark A Brown
- From the Departments of Renal Medicine and Medicine, St. George Hospital and University of New South Wales, Sydney, Australia (M.A.B.)
| | - Laura A Magee
- Faculty of Life Sciences and Medicine, King's College London, United Kingdom (L.A.M.)
| | - Louise C Kenny
- Faculty of Health and Life Sciences, University of Liverpool, United Kingdom (L.C.K.).,INFANT Centre, Cork University Maternity Hospital, Ireland (L.C.K., F.P.M.)
| | - S Ananth Karumanchi
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (S.A.K.)
| | - Fergus P McCarthy
- INFANT Centre, Cork University Maternity Hospital, Ireland (L.C.K., F.P.M.)
| | - Shigeru Saito
- Department of Obstetrics and Gynecology, Graduate School of Medicine and Pharmaceutical Science for Research, University of Toyama, Japan (S.S.)
| | - David R Hall
- Department Obstetrics and Gynecology, Stellenbosch University and Tygerberg Hospital, South Africa (D.R.H.)
| | - Charlotte E Warren
- Reproductive Health Program, Population Council, Washington, DC (C.E.W.)
| | - Gloria Adoyi
- Reproductive Health Program, Population Council-Nigeria, West Africa (G.A., S.I.)
| | - Salisu Ishaku
- Reproductive Health Program, Population Council-Nigeria, West Africa (G.A., S.I.)
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Kalafat E, Mir I, Perry H, Thilaganathan B, Khalil A. Is home blood-pressure monitoring in hypertensive disorders of pregnancy consistent with clinic recordings? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:515-521. [PMID: 29786155 DOI: 10.1002/uog.19094] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/05/2018] [Accepted: 05/08/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To assess the agreement between home blood-pressure monitoring (HBPM) and blood-pressure measurements in a clinic setting, in a cohort of pregnant women with hypertensive disorders of pregnancy (HDP). METHODS This was a cohort study of 147 pregnant women with HDP conducted at St George's Hospital, University of London, London, UK, between 2016 and 2017. Inclusion criteria were chronic hypertension, gestational hypertension or high risk of developing pre-eclampsia, no significant proteinuria and no hematological or biochemical abnormalities. Each included patient was prescribed a personalized schedule of hospital visits and blood-pressure measurements, according to their individual risk as per UK National Institute for Health and Care Excellence guidelines. The blood-pressure measurement at the clinic and the HBPM reading obtained closest to that hospital visit were paired for analysis. Only one pair of measurements was used per patient. Differences between home and clinic blood-pressure measurements were tested using the Wilcoxon signed rank test or paired t-test, and were also assessed visually using Bland-Altman plots. Comparison of the binary outcomes was performed using McNemar's chi-square test. Subgroup analysis was performed in the following gestational-age windows: < 14 weeks, 15-22 weeks, 23-32 weeks and 33-42 weeks' gestation. RESULTS A total of 294 blood-pressure measurements from 147 women were included in the analysis. Median systolic HBPM measurements were significantly lower than clinic measurements (132.0 (interquartile range (IQR), 123.0-140.0) mmHg vs 138.0 (IQR, 132.0-146.5) mmHg; P < 0.001). When stratified according to gestational age, systolic blood-pressure measurements obtained at home were significantly lower than those at clinic in all gestational-age periods except 23-32 weeks' gestation (P = 0.057). Median diastolic blood-pressure measurements at home were also significantly lower than those at clinic (85.0 (IQR, 77.0-90.0) mmHg vs 89.0 (IQR, 82.0-94.0) mmHg; P < 0.001). When stratified according to gestational age, diastolic HBPM measurements were significantly lower in the periods 5-14 weeks (P < 0.001), 15-22 weeks (P = 0.008) and 33-42 weeks (P < 0.001), compared with clinic measurements. The incidence of clinically significant systolic and diastolic hypertension based on clinic blood-pressure measurements was four to five times higher than that based on HBPM measurements (P < 0.001 and P = 0.005, respectively). CONCLUSIONS Our study shows that, in women with HDP, blood pressure measured at home is lower than that measured in a clinic setting. This is consistent with observations in non-pregnant adults, in whom home and ambulatory monitoring of hypertensive patients is recommended. As such, HBPM has the potential to reduce the number of false-positive diagnoses of severe hypertension and unnecessary medical interventions in women with HDP. This must be carefully weighed against the risk of missing true-positive diagnoses. Prospective studies investigating the use of HBPM in pregnant women are urgently needed to determine the relevant blood-pressure thresholds for HBPM, and interval and frequency of monitoring. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- E Kalafat
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Ankara University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
- Middle East Technical University, Department of Statistics, Ankara, Turkey
| | - I Mir
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - H Perry
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - B Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular & Clinical Sciences Research Institute, St George's University of London, London, UK
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular & Clinical Sciences Research Institute, St George's University of London, London, UK
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Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, Hall DR, Warren CE, Adoyi G, Ishaku S. The hypertensive disorders of pregnancy: ISSHP classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens 2018; 13:291-310. [DOI: 10.1016/j.preghy.2018.05.004] [Citation(s) in RCA: 470] [Impact Index Per Article: 78.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Ngene NC, Moodley J. Baseline check of blood pressure readings of an automated device in severe pre-eclampsia and healthy normotensive pregnancy. Pregnancy Hypertens 2018; 12:47-52. [PMID: 29674198 PMCID: PMC5984682 DOI: 10.1016/j.preghy.2018.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/26/2018] [Accepted: 02/28/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The baseline blood pressure (BP) readings of an automated device that have not been validated in pregnancy require comparison with those from a reference standard before the device is utilized in pregnancy. We aimed to perform a baseline check of BP readings of an automated device, Mindray iMEC12 patient monitor, in severe pre-eclampsia and healthy pregnancy. STUDY DESIGN The BP of 50 severe pre-eclamptic and 90 normotensive pregnancies were measured using Mindray iMEC12 patient monitor (test device) and Welch Allyn 767 aneroid sphygmomanometer (reference device). A pass in either the International Organization for Standardization (ISO) or British Hypertension Society (BHS) rating was considered acceptable. The cumulative percentage of absolute BP difference between the test and reference devices within 5, 10 and 15 mmHg were calculated to rate the test device according to the BHS grades (A, B, C or D). The ISO recommends that an accurate device should achieve a mean BP difference ± SD of ≤5 ± 8 mmHg. RESULTS The mean BP difference between the test and reference devices were 1.27 ± 7.51 mmHg and 0.05 ± 6.09 mmHg for systolic and diastolic BPs respectively. The test device achieved the BHS grades B and A rating in systolic and diastolic BPs respectively. In each of the 2 groups (pre-eclamptic and normotensive pregnancies), the test device also satisfied the set pass criteria. CONCLUSIONS In settings that do not have a validated BP device, Mindray iMEC12 patient monitor may be used for BP measurement in normotensive and severe pre-eclamptic pregnancies.
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Affiliation(s)
- Nnabuike C Ngene
- Department of Obstetrics and Gynaecology, University of KwaZulu-Natal, South Africa.
| | - Jagidesa Moodley
- Women's Health and HIV Research Group, Department of Obstetrics and Gynaecology, University of KwaZulu-Natal, South Africa
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Perry H, Sheehan E, Thilaganathan B, Khalil A. Home blood-pressure monitoring in a hypertensive pregnant population. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:524-530. [PMID: 29468771 DOI: 10.1002/uog.19023] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 01/05/2018] [Accepted: 01/30/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The majority of patients with chronic or gestational hypertension do not develop pre-eclampsia. Home blood-pressure monitoring (HBPM) has the potential to offer a more accurate and acceptable means of monitoring hypertensive patients during pregnancy compared with traditional pathways of frequent outpatient monitoring. The aim of this study was to determine whether HBPM reduces visits to antenatal services and is safe in pregnancy. METHODS This was a case-control study of 166 hypertensive pregnant women, which took place at St George's Hospital, University of London. Inclusion criteria were: chronic hypertension, gestational hypertension or high risk of developing pre-eclampsia, no significant proteinuria (≤ 1+ proteinuria on dipstick testing) and normal biochemical and hematological markers. Exclusion criteria were maternal age < 16 years, systolic blood pressure > 155 mmHg or diastolic blood pressure > 100 mmHg, significant proteinuria (≥ 2+ proteinuria on dipstick testing or protein/creatinine ratio > 30 mg/mmol), evidence of small-for-gestational age (estimated fetal weight < 10th centile), signs of severe pre-eclampsia, significant mental health concerns or insufficient understanding of the English language. Pregnant women in the HBPM group were taught how to measure and record their blood pressure using a validated machine at home and attended every 1-2 weeks for assessment depending on clinical need. The control group was managed as per the local protocol prior to the implementation of HBPM. The two groups were compared with respect to number of visits to antenatal services and outcome. RESULTS There were 108 women in the HBPM group and 58 in the control group. There was no difference in maternal age, parity, body mass index, ethnicity or smoking status between the groups, but there were more women with chronic hypertension in the HBPM group compared with the control group (49.1% vs 25.9%, P = 0.004). The HBPM group had significantly fewer outpatient attendances per patient (6.5 vs 8.0, P = 0.003) and this difference persisted when taking into account differences in duration of monitoring (0.8 vs 1.6 attendances per week, P < 0.001). There was no difference in the incidence of adverse maternal, fetal or neonatal outcome between the two groups. CONCLUSION HBPM in hypertensive pregnancies has the potential to reduce the number of hospital visits required by patients without compromising maternal and pregnancy outcomes. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- H Perry
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - E Sheehan
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - B Thilaganathan
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - A Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
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Magee LA, Kenny L, Ananth Karumanchi S, McCarthy F, Saito S, Hall DR, Warren CE, Adoyi G, Mohammed SI. TEMPORARY REMOVAL: The hypertensive disorders of pregnancy: ISSHP classification, diagnosis and management recommendations for international practice 2018. Pregnancy Hypertens 2018. [DOI: 10.1016/j.preghy.2018.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bello NA, Woolley JJ, Cleary KL, Falzon L, Alpert BS, Oparil S, Cutter G, Wapner R, Muntner P, Tita AT, Shimbo D. Accuracy of Blood Pressure Measurement Devices in Pregnancy: A Systematic Review of Validation Studies. Hypertension 2017; 71:326-335. [PMID: 29229741 DOI: 10.1161/hypertensionaha.117.10295] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 10/03/2017] [Accepted: 11/16/2017] [Indexed: 11/16/2022]
Abstract
The accurate measurement of blood pressure (BP) in pregnancy is essential to guide medical decision making that affects both mother and fetus. The aim of this systematic review was to determine the accuracy of ambulatory, home, and clinic BP measurement devices in pregnant women. We searched Ovid MEDLINE, The Cochrane Library, EMBASE, CINAHL EBSCO, ClinicalTrials.gov, International Clinical Trials Registry Platform, and dabl from inception through August 3, 2017 for articles that assessed the validity of an upper arm BP measurement device against a mercury sphygmomanometer in pregnant women. Two independent investigators determined eligibility, extracted data, and adjudicated protocol violations. From 1798 potential articles identified, 41, that assessed 28 devices, met the inclusion criteria. Most articles (n=32) followed a standard or modified American National Standards Institute/Association for the Advancement of Medical Instrumentation/International Organization for Standardization, British Hypertension Society, or European Society of Hypertension validation protocol. Several articles described the results of validation studies performed on >1 device (n=7) or in >1 population of pregnant women (n=12), comprising 64 pairwise validity assessments. The device was validated in 61% (32 of 52) of studies which used a standard or modified protocol. Only 34% (11 of 32) of the studies wherein the device was successfully validated were performed without a protocol violation. Given the implications of inaccurate BP measurement in pregnant women, healthcare providers should be aware of and try to use the BP measurement devices which have been properly validated in this population.
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Affiliation(s)
- Natalie A Bello
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham.
| | - Jonathan J Woolley
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham
| | - Kirsten Lawrence Cleary
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham
| | - Louise Falzon
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham
| | - Bruce S Alpert
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham
| | - Suzanne Oparil
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham
| | - Gary Cutter
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham
| | - Ronald Wapner
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham
| | - Paul Muntner
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham
| | - Alan T Tita
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham
| | - Daichi Shimbo
- From the Department of Medicine (N.A.B., L.F., D.S.) and Department of Obstetrics and Gynecology (K.L.C., R.W.), Columbia University Medical Center, New York, NY; Department of Economics, California Polytechnic State University, San Luis Obispo (J.J.W.); Department of Pediatrics, University of Tennessee Health Science Center, Memphis (B.S.A.); and Department of Medicine (S.O.), Department of Biostatistics (G.C.), Department of Epidemiology (P.M.), and Department of Obstetrics and Gynecology and Center for Women's Reproductive Health (A.T.T.), University of Alabama at Birmingham
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Lan PG, Hyett J, Gillin AG. Home blood pressure measurement in women with pregnancy-related hypertensive disorders. Pregnancy Hypertens 2017; 10:213-219. [PMID: 29153682 DOI: 10.1016/j.preghy.2017.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 08/17/2017] [Accepted: 09/10/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine if home blood pressure measurement (HBPM) provides comparable results to clinic blood pressure (BP) measurement. STUDY DESIGN A prospective, single-centre study of 37 pregnant and early post-partum women with a hypertensive pregnancy or at high-risk of developing a hypertensive pregnancy were asked to perform HBPM for a minimum period of one week. This was subsequently compared to clinic BP measurement both before and after the period of home measurement. MAIN OUTCOME MEASURES The accuracy of HBPM compared to clinic measurement, and the acceptability by patients for HBPM. RESULTS The HBPM was comparable to clinic measurements [for the systolic blood pressure (SBP), the mean home reading was 123.4mmHg (122.0-124.9mmHg) versus 123.9mmHg (121.3-126.5mmHg) for the clinic reading (p=0.69); for the diastolic blood pressure (DBP) the mean home reading was 81.6mmHg (80.4-82.8mmHg) versus 84.4mmHg (82.6-86.2mmHg) for the clinic (p<0.01)]. There were no reported issues associated with the use of HBPM, but it did lead to 5 women contacting health care professionals for management of their BP between clinic visits. CONCLUSIONS HBPM provides comparable results to the clinic BP measurement. It is also an acceptable technique for pregnant and early post-partum women. However, it should be used as an adjunct to clinic measurement, and cannot at this present stage replace clinic visits or clinic BP measurement.
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Affiliation(s)
- Patrick G Lan
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia; Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia.
| | - Jon Hyett
- Department of High Risk Obstetrics, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia; Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, NSW 2006, Australia
| | - Adrian G Gillin
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia; Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
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