Virtual BP Monitoring Lowers Readmissions Among Postpartum Patients

June 30, 2023 - Among those with hypertensive disorders of pregnancy (HDP), a blood pressure (BP) home monitoring resource combined with the use of medication for BP titration helped with keeping patients out of the hospital and keeping systolic blood pressure (SBP) at a healthy level.

Data from the Centers for Disease Control and Prevention (CDC) indicated that the frequency of HDP rose from 13.3 percent to 15.9 percent between 2017 and 2019. The CDC also noted that these conditions are the leading causes of pregnancy-related deaths in the US.

Amid the growth of virtual care resources in healthcare, researchers aimed to determine whether home BP monitoring could treat HDP patients. The primary goal was for patients to achieve an SBP of 130/80 mm Hg or lower by six weeks postpartum.

The study population included 62 postpartum patients, 23 percent of whom had chronic hypertension (cHTN), 45 percent had gestational hypertension (gHTN), and 31 percent had preeclampsia. All participants delivered at Massachusetts General Hospital between February and May 2021. Researchers also used data from an observational cohort of 79 HDP patients as a historical reference group with data from 2020.

All participants either owned a BP cuff or received one for the study. They also received education on BP measurement, hypertension, and HDP.

Participants provided researchers with self-measured BP readings, which they then used to initiate or titrate medication. Subjective decisions were based on a study algorithm that aimed to reach a BP of less than 130/80 mm Hg by six weeks postpartum. Researchers defined hospital readmission within six weeks postpartum as the primary outcome. BP in this six-week period and frequency of medication titration were the secondary outcomes.

Among those with cHTN and preeclampsia, half were put on antihypertensives. This was also the case among 10 percent of those with gHTN.

Among the 42 patients who participated in the full duration of the intervention, 7 percent were readmitted for hypertension. All readmissions took place within the first week following discharge. This share was smaller than that of the historical cohort, which reported a 10 percent readmission rate.

Compared to the historical cohort, the home-based BP monitoring intervention also led to better rates of healthy blood pressure. Among study participants, 95 percent reached a sub-130/80 mm Hg SBP within six weeks. This share was only 78 percent in the historical cohort.

Researchers also noted that 31 percent of patients remained on antihypertensives at the six-week postpartum mark.

Although many study participants experienced medication initiation and titration, the study results indicate a high success rate. Limitations, however, relate to the small population of the study and a non-thorough completion rate. These show the need for methods to improve engagement among diverse populations.

As efforts to assist postpartum women expand, virtual care is increasingly involved.

In January, the state of Michigan began offering the Philips Pregnancy+ mobile application to Medicaid-eligible families. The goal was to support state residents through their pregnancy and postpartum periods.

Through this app, patients had access to information on fetal growth and personalized support. This included a feed that recommended relevant content, tools, and health department programs to assist patients at specific points in their pregnancy and postpartum journey.