High blood pressure during and after pregnancy can put both mother and baby at risk. So does showing new mothers how to monitor their own blood pressure, and control their own blood pressure medication accordingly, improve their health outcomes more than those who receive standard care?

aims

This project wants to find out if home blood pressure monitoring, and self-adjustment of blood pressure medications (according to a bespoke plan), improve blood pressure control and patient satisfaction in women with new-onset raised blood pressure during pregnancy.

Why this is important

Around one in ten pregnant women develop ‘new-onset’ high blood pressure (also called ‘hypertension’). For some, this comes combined with protein in their urine, a condition called pre-eclampsia, which can lead to serious complications for both mother and baby.

High blood pressure in pregnancy is a risk factor for developing strokes, and can lead to other complications for both mother and baby. However, medication can help lower high blood pressure, reducing the risk of developing these complications. Raised blood pressure in pregnancy is also a risk factor for developing chronic raised blood pressure, heart disease and stroke later in life.

After birth, women’s blood pressure usually remains high for a while, taking about 2–12 weeks to come back to normal.  Over this time, medication is continued and monitored outside of hospital, to prevent over-treatment.

However, research suggests that people with more normal blood pressure during this time have better long-term health outcomes.

As such, managing post-birth blood pressure better may improve health outcomes for these patients. But few clinical studies have looked at the management of blood pressure following birth.

Recently Theme 5 Leader, Professor Richard McManus, showed that people who monitor their own blood pressure and adjust their medication accordingly are better at lowering their blood pressure than those who receive normal care (e.g. monitoring by their GP).

Women with new-onset raised blood pressure in pregnancy would seem to be an ideal group to test Professor McManus’ work, to see if it would also make a difference for them.

Methods

Women at different hospitals, who have developed new-onset raised blood pressure in pregnancy, will be contacted to see if they wish to take part in the study.

Those who do will be randomly split in to one of two groups. One group will receive normal care – monitoring of blood pressure and adjustment of medication by a health professional, such as their GP and community midwife – while the other will self-manage their medication.

The self-management group will be given, and taught to use, a home blood pressure monitor. These monitors have been tested to show they are accurate during and after pregnancy.  They will take daily blood pressure readings and adjust their own mediation accordingly, until they have discontinued treatment.

This is a small scale, preliminary study, called a pilot study, aiming to work with about 100 patients. It will be used to help inform how best to do a larger-scale study, gathering information on how workable it is and how best to coordinate it.

It will also give an idea of how participants view self-management, how well the treatment works, and what are the best measures of this.

Finally, the pilot study will help the researchers to work out how many people would need to be involved for the study to collect accurate, reliable data to see if, and how well, the treatment works or not.

How this could benefit patients

Ultimately, this research wants to improve the long-term health and post-birth management of high blood pressure for women with new on-set high blood pressure and pre-eclampsia.

We hope that all participants in the trial will achieve blood pressure control that is at least as good, but hopefully better, than standard care currently offers.

Self-management may also benefit women by needing to schedule fewer GP and midwife appointments in the period immediately following discharge from hospital, and empowering women to take control of their own care.

Self-management could also help to reduce the burden on community healthcare and primary care, such as GPs and community midwives, freeing up resources for other people and health conditions.

Next steps

If you would like to take part in this trial, contact details for the study are as follows:

Chief Investigator: Alexandra Cairns 0800 9150045 alexandra.cairns@phc.ox.ac.uk

If you are a healthcare professional looking for more information please see the following website (Trial Registration), or contact the Chief Investigator (contact details below):

https://clinicaltrials.gov/ct2/show/NCT02333240?term=self-management+AND+postnatal&rank=1

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