Postpartum home blood pressure monitoring and lifestyle intervention in
the first year after a hypertensive disorder of pregnancy: A pilot
feasibility trial
Abstract
Objective: To test the feasibility of a randomized trial of home blood
pressure monitoring paired with a remote lifestyle intervention vs. home
blood pressure monitoring alone vs. control in individuals with a
hypertensive disorder of pregnancy in the first year postpartum. Design:
Single-blinded randomized clinical trial Setting: Two tertiary hospitals
and a community organization Population: Overweight and obese
individuals with a hypertensive disorder of pregnancy and without
pre-pregnancy hypertension or diabetes. Methods: We assessed the
feasibility of recruitment and retention of 150 participants to study
completion at one-year postpartum with randomization 1:1:1 into each
arm. Secondary aims were to test effects of the interventions on weight,
blood pressure and self-efficacy. Results: Over 23 months, we enrolled
148 of 400 eligible, screened individuals (37%); 28% Black or Other
race, and mean pre-pregnancy BMI of 33.4±6.7 kg/m2. In total, 129 (87%)
participants completed the one-year postpartum study visit. Overall,
22% of participants developed stage 2 hypertension [≥140/90 mmHg or
on anti-hypertensive medications] by one-year postpartum. Individuals
in the lifestyle intervention arm had a greater, non-significant
decrease in mean arterial pressure (MAP) compared to individuals in the
HBPM alone and control arm [mean change in MAP (95%CI) -3.7(-6.5,
-0.9), -0.5(-1.5, 2.6), -1.0(-4.1, 2.2) mmHg], respectively. There
were no differences in weight or self-efficacy by study arms.
Conclusion: In this pilot, randomized trial, we demonstrate feasibility
of HBPM paired with a lifestyle intervention in the first year
postpartum. We detected high rates of ongoing hypertension emphasizing
the need for effective interventions in this population.