Self-Management of Postnatal Hypertension: The SNAP-HT Trial

Hypertension affects 1 in 10 pregnancies, often persisting postpartum, when antihypertensive requirements may vary substantially. This unmasked, randomized controlled trial evaluated the feasibility and effects on blood pressure (BP) of self-management of postpartum hypertension. Women with gestatio...

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Published inHypertension (Dallas, Tex. 1979) Vol. 72; no. 2; pp. 425 - 432
Main Authors Cairns, Alexandra E., Tucker, Katherine L., Leeson, Paul, Mackillop, Lucy H., Santos, Mauro, Velardo, Carmelo, Salvi, Dario, Mort, Sam, Mollison, Jill, Tarassenko, Lionel, McManus, Richard J., Crawford, Carole, Edwards, Claire, Baker, Natasha, Selinger, Mark, Lloyd, Sue, Tebbutt, Julie, Ashworth, Felicity, Pullon, Rebecca
Format Journal Article
LanguageEnglish
Published United States American Heart Association, Inc 01.08.2018
Subjects
Adult
Antihypertensive Agents - therapeutic use
Blood Pressure - physiology
Blood Pressure Monitoring, Ambulatory - methods
Female
Follow-Up Studies
Humans
Hypertension, Pregnancy-Induced - drug therapy
Hypertension, Pregnancy-Induced - physiopathology
Pregnancy
Prospective Studies
Self-Management - methods
Treatment Outcome
blood pressure
postpartum period
pregnancy
preeclampsia
hypertension
self-management
women
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Abstract Hypertension affects 1 in 10 pregnancies, often persisting postpartum, when antihypertensive requirements may vary substantially. This unmasked, randomized controlled trial evaluated the feasibility and effects on blood pressure (BP) of self-management of postpartum hypertension. Women with gestational hypertension or preeclampsia, requiring postnatal antihypertensive treatment, were randomized to self-management or usual care. Self-management entailed daily home BP monitoring and automated medication reduction via telemonitoring. Women attended 5 follow-up visits during 6 months. The primary outcome was feasibilityspecifically recruitment, retention, and compliance with follow-up rates. Secondary outcomes included BP control and safety, analyzed on an intention-to-treat basis. Forty-nine percent (91/186) of those women approached were randomized (45 intervention, 46 control), and 90% (82/91) finished follow-up. The groups had similar baseline characteristics. After randomization, BP was lower in the intervention group, most markedly at 6 weeksintervention group mean (SD), systolic 121.6 (8.7)/diastolic 80.5 (6.6) mm Hg; control group, systolic 126.6 (11.0)/diastolic 86.0 (9.7) mm Hg; adjusted differences (95% confidence interval), systolic −5.2 (−9.3 to −1.2)/diastolic −5.8 (−9.1 to −2.5) mm Hg. Diastolic BP remained significantly lower in those self-managing to 6 monthsadjusted difference −4.5 (−8.1 to −0.8) mm Hg. This is the first randomized evaluation of BP self-management postpartum and indicates it would be feasible to trial this intervention in larger studies. Self-management resulted in better diastolic BP control to 6 months, even beyond medication cessation. CLINICAL TRIAL REGISTRATION—URLhttp://www.clinicaltrials.gov. Unique identifierNCT02333240.
AbstractList Hypertension affects 1 in 10 pregnancies, often persisting postpartum, when antihypertensive requirements may vary substantially. This unmasked, randomized controlled trial evaluated the feasibility and effects on blood pressure (BP) of self-management of postpartum hypertension. Women with gestational hypertension or preeclampsia, requiring postnatal antihypertensive treatment, were randomized to self-management or usual care. Self-management entailed daily home BP monitoring and automated medication reduction via telemonitoring. Women attended 5 follow-up visits during 6 months. The primary outcome was feasibility: specifically recruitment, retention, and compliance with follow-up rates. Secondary outcomes included BP control and safety, analyzed on an intention-to-treat basis. Forty-nine percent (91/186) of those women approached were randomized (45 intervention, 46 control), and 90% (82/91) finished follow-up. The groups had similar baseline characteristics. After randomization, BP was lower in the intervention group, most markedly at 6 weeks: intervention group mean (SD), systolic 121.6 (8.7)/diastolic 80.5 (6.6) mm Hg; control group, systolic 126.6 (11.0)/diastolic 86.0 (9.7) mm Hg; adjusted differences (95% confidence interval), systolic -5.2 (-9.3 to -1.2)/diastolic -5.8 (-9.1 to -2.5) mm Hg. Diastolic BP remained significantly lower in those self-managing to 6 months: adjusted difference -4.5 (-8.1 to -0.8) mm Hg. This is the first randomized evaluation of BP self-management postpartum and indicates it would be feasible to trial this intervention in larger studies. Self-management resulted in better diastolic BP control to 6 months, even beyond medication cessation. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02333240.
Hypertension affects 1 in 10 pregnancies, often persisting postpartum, when antihypertensive requirements may vary substantially. This unmasked, randomized controlled trial evaluated the feasibility and effects on blood pressure (BP) of self-management of postpartum hypertension. Women with gestational hypertension or preeclampsia, requiring postnatal antihypertensive treatment, were randomized to self-management or usual care. Self-management entailed daily home BP monitoring and automated medication reduction via telemonitoring. Women attended 5 follow-up visits during 6 months. The primary outcome was feasibility: specifically recruitment, retention, and compliance with follow-up rates. Secondary outcomes included BP control and safety, analyzed on an intention-to-treat basis. Forty-nine percent (91/186) of those women approached were randomized (45 intervention, 46 control), and 90% (82/91) finished follow-up. The groups had similar baseline characteristics. After randomization, BP was lower in the intervention group, most markedly at 6 weeks: intervention group mean (SD), systolic 121.6 (8.7)/diastolic 80.5 (6.6) mm Hg; control group, systolic 126.6 (11.0)/diastolic 86.0 (9.7) mm Hg; adjusted differences (95% confidence interval), systolic -5.2 (-9.3 to -1.2)/diastolic -5.8 (-9.1 to -2.5) mm Hg. Diastolic BP remained significantly lower in those self-managing to 6 months: adjusted difference -4.5 (-8.1 to -0.8) mm Hg. This is the first randomized evaluation of BP self-management postpartum and indicates it would be feasible to trial this intervention in larger studies. Self-management resulted in better diastolic BP control to 6 months, even beyond medication cessation.Hypertension affects 1 in 10 pregnancies, often persisting postpartum, when antihypertensive requirements may vary substantially. This unmasked, randomized controlled trial evaluated the feasibility and effects on blood pressure (BP) of self-management of postpartum hypertension. Women with gestational hypertension or preeclampsia, requiring postnatal antihypertensive treatment, were randomized to self-management or usual care. Self-management entailed daily home BP monitoring and automated medication reduction via telemonitoring. Women attended 5 follow-up visits during 6 months. The primary outcome was feasibility: specifically recruitment, retention, and compliance with follow-up rates. Secondary outcomes included BP control and safety, analyzed on an intention-to-treat basis. Forty-nine percent (91/186) of those women approached were randomized (45 intervention, 46 control), and 90% (82/91) finished follow-up. The groups had similar baseline characteristics. After randomization, BP was lower in the intervention group, most markedly at 6 weeks: intervention group mean (SD), systolic 121.6 (8.7)/diastolic 80.5 (6.6) mm Hg; control group, systolic 126.6 (11.0)/diastolic 86.0 (9.7) mm Hg; adjusted differences (95% confidence interval), systolic -5.2 (-9.3 to -1.2)/diastolic -5.8 (-9.1 to -2.5) mm Hg. Diastolic BP remained significantly lower in those self-managing to 6 months: adjusted difference -4.5 (-8.1 to -0.8) mm Hg. This is the first randomized evaluation of BP self-management postpartum and indicates it would be feasible to trial this intervention in larger studies. Self-management resulted in better diastolic BP control to 6 months, even beyond medication cessation.URL: http://www.clinicaltrials.gov. Unique identifier: NCT02333240.CLINICAL TRIAL REGISTRATIONURL: http://www.clinicaltrials.gov. Unique identifier: NCT02333240.
Hypertension affects 1 in 10 pregnancies, often persisting postpartum, when antihypertensive requirements may vary substantially. This unmasked, randomized controlled trial evaluated the feasibility and effects on blood pressure (BP) of self-management of postpartum hypertension. Women with gestational hypertension or preeclampsia, requiring postnatal antihypertensive treatment, were randomized to self-management or usual care. Self-management entailed daily home BP monitoring and automated medication reduction via telemonitoring. Women attended 5 follow-up visits during 6 months. The primary outcome was feasibility: specifically recruitment, retention, and compliance with follow-up rates. Secondary outcomes included BP control and safety, analyzed on an intention-to-treat basis. Forty-nine percent (91/186) of those women approached were randomized (45 intervention, 46 control), and 90% (82/91) finished follow-up. The groups had similar baseline characteristics. After randomization, BP was lower in the intervention group, most markedly at 6 weeks: intervention group mean (SD), systolic 121.6 (8.7)/diastolic 80.5 (6.6) mm Hg; control group, systolic 126.6 (11.0)/diastolic 86.0 (9.7) mm Hg; adjusted differences (95% confidence interval), systolic −5.2 (−9.3 to −1.2)/diastolic −5.8 (−9.1 to −2.5) mm Hg. Diastolic BP remained significantly lower in those self-managing to 6 months: adjusted difference −4.5 (−8.1 to −0.8) mm Hg. This is the first randomized evaluation of BP self-management postpartum and indicates it would be feasible to trial this intervention in larger studies. Self-management resulted in better diastolic BP control to 6 months, even beyond medication cessation.
Hypertension affects 1 in 10 pregnancies, often persisting postpartum, when antihypertensive requirements may vary substantially. This unmasked, randomized controlled trial evaluated the feasibility and effects on blood pressure (BP) of self-management of postpartum hypertension. Women with gestational hypertension or preeclampsia, requiring postnatal antihypertensive treatment, were randomized to self-management or usual care. Self-management entailed daily home BP monitoring and automated medication reduction via telemonitoring. Women attended 5 follow-up visits during 6 months. The primary outcome was feasibilityspecifically recruitment, retention, and compliance with follow-up rates. Secondary outcomes included BP control and safety, analyzed on an intention-to-treat basis. Forty-nine percent (91/186) of those women approached were randomized (45 intervention, 46 control), and 90% (82/91) finished follow-up. The groups had similar baseline characteristics. After randomization, BP was lower in the intervention group, most markedly at 6 weeksintervention group mean (SD), systolic 121.6 (8.7)/diastolic 80.5 (6.6) mm Hg; control group, systolic 126.6 (11.0)/diastolic 86.0 (9.7) mm Hg; adjusted differences (95% confidence interval), systolic −5.2 (−9.3 to −1.2)/diastolic −5.8 (−9.1 to −2.5) mm Hg. Diastolic BP remained significantly lower in those self-managing to 6 monthsadjusted difference −4.5 (−8.1 to −0.8) mm Hg. This is the first randomized evaluation of BP self-management postpartum and indicates it would be feasible to trial this intervention in larger studies. Self-management resulted in better diastolic BP control to 6 months, even beyond medication cessation. CLINICAL TRIAL REGISTRATION—URLhttp://www.clinicaltrials.gov. Unique identifierNCT02333240.
Author Edwards, Claire
Mollison, Jill
Pullon, Rebecca
Ashworth, Felicity
Mort, Sam
Salvi, Dario
Mackillop, Lucy H.
Santos, Mauro
Tucker, Katherine L.
Tarassenko, Lionel
Tebbutt, Julie
Lloyd, Sue
McManus, Richard J.
Baker, Natasha
Velardo, Carmelo
Crawford, Carole
Cairns, Alexandra E.
Selinger, Mark
Leeson, Paul
AuthorAffiliation From the Nuffield Department of Primary Care Health Sciences (A.E.C., K.L.T., S.M., J.M., R.J.M.) Cardiovascular Clinical Research Facility (P.L.) Nuffield Department of Obstetrics and Gynaecology (L.H.M.) Institute of Biomedical Engineering (M.S., C.V., D.S., L.T.), University of Oxford, United Kingdom. University of Oxford University of Oxford Royal Berkshire NHS Foundation Trust Royal Berkshire NHS Foundation Trust Northampton General Hospital NHS Trust Buckinghamshire Healthcare NHS Trust Buckinghamshire Healthcare NHS Trust University of Oxford
AuthorAffiliation_xml – name: From the Nuffield Department of Primary Care Health Sciences (A.E.C., K.L.T., S.M., J.M., R.J.M.) Cardiovascular Clinical Research Facility (P.L.) Nuffield Department of Obstetrics and Gynaecology (L.H.M.) Institute of Biomedical Engineering (M.S., C.V., D.S., L.T.), University of Oxford, United Kingdom. University of Oxford University of Oxford Royal Berkshire NHS Foundation Trust Royal Berkshire NHS Foundation Trust Northampton General Hospital NHS Trust Buckinghamshire Healthcare NHS Trust Buckinghamshire Healthcare NHS Trust University of Oxford
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/29967037$$D View this record in MEDLINE/PubMed
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ContentType Journal Article
Contributor Tebbutt, Julie
Edwards, Claire
Lloyd, Sue
Pullon, Rebecca
Baker, Natasha
Ashworth, Felicity
Crawford, Carole
Selinger, Mark
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Copyright 2018 American Heart Association, Inc
2018 American Heart Association, Inc.
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– notice: 2018 American Heart Association, Inc.
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SNAP-HT Investigators
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Issue 2
Keywords blood pressure
postpartum period
pregnancy
preeclampsia
hypertension
self-management
women
Language English
License 2018 American Heart Association, Inc.
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PublicationTitle Hypertension (Dallas, Tex. 1979)
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29967042 - Hypertension. 2018 Aug;72(2):296-297. doi: 10.1161/HYPERTENSIONAHA.118.11044.
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Snippet Hypertension affects 1 in 10 pregnancies, often persisting postpartum, when antihypertensive requirements may vary substantially. This unmasked, randomized...
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SubjectTerms Adult
Antihypertensive Agents - therapeutic use
Blood Pressure - physiology
Blood Pressure Monitoring, Ambulatory - methods
Female
Follow-Up Studies
Humans
Hypertension, Pregnancy-Induced - drug therapy
Hypertension, Pregnancy-Induced - physiopathology
Pregnancy
Prospective Studies
Self-Management - methods
Treatment Outcome
Title Self-Management of Postnatal Hypertension: The SNAP-HT Trial
URI https://www.ncbi.nlm.nih.gov/pubmed/29967037
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Volume 72
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