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

Tucker, K. L., Mort, S., Yu, L-Y. , Campbell, H., Rivero-Arias, O., Wilson, H., Allen, J., Band, R., Chisholm, A., Crawford, C., Dougall, G., Engonidou, L., Franssen, M., Green, M., Greenfield, S., Hinton, L., Hodgkinson, J., Lavallee, L., Leeson, P., McCourt, C. ORCID: 0000-0003-4765-5795, Mackillop, L., Sandall, J., Santos, M., Tarassenko, L., Velardo, C., Yardley, L., Chappell, L. C., McManus, R. J. & BUMP Investigators, (2022). Effect of Self-monitoring of Blood Pressure on Diagnosis of Hypertension During Higher-Risk Pregnancy: The BUMP 1 Randomized Clinical Trial. JAMA, 327(17), pp. 1656-1665. doi: 10.1001/jama.2022.4712

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

Publication Type: Article
Subjects: R Medicine > RC Internal medicine
R Medicine > RG Gynecology and obstetrics
Departments: School of Health & Psychological Sciences > Midwifery & Radiography
[img] Text - Accepted Version
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