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 OxfordUniversity of OxfordRoyal Berkshire NHS Foundation TrustRoyal Berkshire NHS Foundation TrustNorthampton General Hospital NHS TrustBuckinghamshire Healthcare NHS TrustBuckinghamshire Healthcare NHS TrustUniversity of Oxford
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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.Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT02333240.