Automated postnatal home blood pressure monitoring identifies significant cardiovascular disease

Abstract

This study involved prospective postnatal monitoring of women with hypertensive disorders of pregnancy in order to establish an accurate diagnosis and initiate appropriate long-term management of hypertensive women. Recent reports of reductions in adult cardiovascular morbidity with pharmacological intervention have highlighted the importance of correctly identifying women who have hypertension prolonged beyond their pregnancy. Conventional postnatal follow-up is often incomplete. We present data from our ongoing postnatal blood pressure surveillance programme. Women with pregnancies complicated by hypertension and requiring antihypertensive therapy during the peripartum period have been enrolled prospectively into the programme. The women were instructed on the use of the Omron-RX wrist blood pressure monitor and readings were reviewed regularly by a specialist midwife who advised on medication alteration/discontinuation based on an algorithm. Patients recording elevated readings at 12 weeks postpartum are further assessed with ABPM before referral to a hypertension physician. A total of 370 women have completed the programme to date: 155 pre-eclamptics/eclamptics, 188 gestational hypertensives and 27 essential hypertensives. The mean postnatal inpatient stay ranged from 6.8 days (HELLP) to 3.4 days (gestational hypertensives). A total of 248 women were discharged home on antihypertensive therapy and required surveillance for a mean of 39.4 days (range 7–91); 39/302 women (12.9%) were diagnosed as chronic hypertensives based on persisting postpartum hypertension confirmed by ABPM and the programme triggered specialist referral at >12 weeks postpartum for long-term management in 55 women (16.7%).