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Original Investigation
May 3, 2022

Effect of Self-monitoring of Blood Pressure on Diagnosis of Hypertension During Higher-Risk Pregnancy: The BUMP 1 Randomized Clinical Trial

Author Affiliations
  • 1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
  • 2National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
  • 3Department of Women and Children’s Health, King’s College London, St Thomas’ Hospital, London, United Kingdom
  • 4Department of Psychology, University of Southampton, Southampton, United Kingdom
  • 5Action on Pre-eclampsia, The Stables, Evesham, Worcestershire, United Kingdom
  • 6Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
  • 7The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, United Kingdom
  • 8Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
  • 9Centre for Maternal and Child Health Research, City, University of London, London, United Kingdom
  • 10Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
  • 11Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
  • 12School of Psychological Science, University of Bristol, Bristol, United Kingdom
JAMA. 2022;327(17):1656-1665. doi:10.1001/jama.2022.4712
Visual Abstract. Self-monitoring of Blood Pressure and Hypertension Diagnosis During Higher-Risk Pregnancy
Self-monitoring of Blood Pressure and Hypertension Diagnosis During Higher-Risk Pregnancy
Key Points

Question  Does self-monitoring of blood pressure (BP) by pregnant individuals at higher risk for preeclampsia lead to earlier detection of pregnancy hypertension compared with usual antenatal care?

Findings  In this randomized clinical trial that included 2441 pregnant individuals at increased risk for preeclampsia, self-monitoring of BP with telemonitoring compared with usual care resulted in a mean time to clinic-based detection of hypertension of 104 vs 106 days, a difference that was not statistically significant.

Meaning  Among pregnant individuals at higher risk of preeclampsia, self-monitoring of BP with telemonitoring did not lead to earlier clinic-based detection of hypertension.

Abstract

Importance  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.

Objective  To determine whether self-monitoring of BP in higher-risk pregnancies leads to earlier detection of pregnancy hypertension.

Design, Setting, and Participants  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.

Interventions  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.

Main Outcomes and Measures  The primary outcome was time to first recorded hypertension measured by a health care professional.

Results  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]; P = .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).

Conclusions and Relevance  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.

Trial Registration  ClinicalTrials.gov Identifier: NCT03334149

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