The University of Southampton
University of Southampton Institutional Repository

Effect of self-monitoring of blood pressure on blood pressure control in pregnant individuals with chronic or gestational hypertension: the BUMP 2 randomized clinical trial

Effect of self-monitoring of blood pressure on blood pressure control in pregnant individuals with chronic or gestational hypertension: the BUMP 2 randomized clinical trial
Effect of self-monitoring of blood pressure on blood pressure control in pregnant individuals with chronic or gestational hypertension: the BUMP 2 randomized clinical trial

Importance: inadequate management of elevated blood pressure is a significant contributing factor to maternal deaths. The role of blood pressure self-monitoring in pregnancy in improving clinical outcomes for the pregnant individual and infant is unclear. Objective: To evaluate the effect of blood pressure self-monitoring, compared with usual care alone, on blood pressure control and other related maternal and infant outcomes, in individuals with pregnancy hypertension. 

Design, setting, and participants: unblinded, randomized clinical trial that recruited between November 2018 and September 2019 in 15 hospital maternity units in England. Individuals with chronic hypertension (enrolled up to 37 weeks' gestation) or with gestational hypertension (enrolled between 20 and 37 weeks' gestation). Final follow-up was in May 2020. Interventions: Participants were randomized to either blood pressure self-monitoring using a validated monitor and a secure telemonitoring system in addition to usual care (n = 430) or to usual care alone (n = 420). Usual care comprised blood pressure measured by health care professionals at regular antenatal clinics. 

Main outcomes and measures: the primary maternal outcome was the difference in mean systolic blood pressure recorded by health care professionals between randomization and birth. Results: Among 454 participants with chronic hypertension (mean age, 36 years; mean gestation at entry, 20 weeks) and 396 with gestational hypertension (mean age, 34 years; mean gestation at entry, 33 weeks) who were randomized, primary outcome data were available from 444 (97.8%) and 377 (95.2%), respectively. In the chronic hypertension cohort, there was no statistically significant difference in mean systolic blood pressure for the self-monitoring groups vs the usual care group (133.8 mm Hg vs 133.6 mm Hg, respectively; adjusted mean difference, 0.03 mm Hg [95% CI, -1.73 to 1.79]). In the gestational hypertension cohort, there was also no significant difference in mean systolic blood pressure (137.6 mm Hg compared with 137.2 mm Hg; adjusted mean difference, -0.03 mm Hg [95% CI, -2.29 to 2.24]). There were 8 serious adverse events in the self-monitoring group (4 in each cohort) and 3 in the usual care group (2 in the chronic hypertension cohort and 1 in the gestational hypertension cohort). 

Conclusions andrelevance: among pregnant individuals with chronic or gestational hypertension, blood pressure self-monitoring with telemonitoring, compared with usual care, did not lead to significantly improved clinic-based blood pressure control. Trial Registration: ClinicalTrials.gov Identifier: NCT03334149.

0098-7484
1666-1678
Chappell, Lucy C.
775968ae-30c1-4084-beb0-11de8c90d611
Tucker, Katherine L.
990b0f31-7275-4261-8917-33b6e3002db0
Galal, Ushma
0148bc60-aabf-4e18-a3cf-5a39d255c63a
Yu, Ly-mee
849f372f-1a44-4941-af2e-0f4d0814fe86
Campbell, Helen
b776b7ea-8f26-4a57-9a17-35ef8b434497
Rivero-arias, Oliver
cd7dc5a8-d0b5-4dbd-a752-21ed6bad9b78
Allen, Julie
e974f668-2d71-467e-b3bd-3063f778ff53
Band, Rebecca
be8901bb-bb1b-4131-8e19-c1d4a3bdfb8d
Chisholm, Alison
b9c6e5d9-a4f3-4d05-aaa4-a1435fdc7771
Crawford, Carole
0e0d6662-b51a-41b1-8b2c-b33b1dd612c4
Dougall, Greig
61c47885-7736-40c9-a214-2fa895c8b382
Engonidou, Lazarina
23ca67fd-4063-47bd-b717-09d55d036d0b
Franssen, Marloes
299bcf45-0f42-4857-9d79-c4e4ce5c62cb
Green, Marcus
c28e0886-52a6-4926-aeb0-07c49760d7a9
Greenfield, Sheila
a983610e-aa36-442b-9f11-9af5721d7542
Hinton, Lisa
b260bc3f-3ecd-4202-b52a-6d606a6b3b92
Hodgkinson, James
1a369cb0-a81f-4af5-9b94-1d49e2f50a41
Lavallee, Layla
8c7676f3-697b-41b8-a56b-e570c340b3e4
Leeson, Paul
34dc217d-32e6-4c63-bcbb-334844939c92
Mccourt, Christine
597a251a-8e9d-4e38-9ce7-0b672603017a
Mackillop, Lucy
1c89c5c7-390b-4fcb-a941-7b94418bc0a5
Sandall, Jane
76109d47-f08b-480e-8c43-f2c18d7a1feb
Santos, Mauro
dd6fbde2-f0da-42f1-8ffd-96222d8038ba
Tarassenko, Lionel
2fc74dff-9b06-410f-92f5-63f2270a091c
Velardo, Carmelo
57266feb-8387-43c7-9d98-df28971f0e03
Wilson, Hannah
316ddb2e-6b57-45c7-9183-09520099f5ec
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Mcmanus, Richard J.
481f6284-d599-4c77-8869-d1c6b63b9b02
Cook, Johanna
2eb21e4e-2058-49ce-99a2-262d438bf988
Coates, Maria
4bece266-f962-40a0-8289-cfa22c3a9d1c
Gabriel, Thomas
bfe8de7c-4293-4f2a-ba7e-8f6898f5cbb7
Brann, Stephanie
90dbd09b-c441-4199-82b8-394d68921c12
De Henau, Joris
5ccf6331-910a-4613-a108-73fb36e4d587
Kelly, Sadie
00c2d18c-403a-41f2-a83d-007e0f7cb7b8
Watt, Dave
f31e1f83-b0d8-4fc9-a4ce-57385c52b839
Judge, David
66734c4b-626c-4609-95c6-a9e008a07f95
Castello, Luis
165d643a-0f5d-452c-a47c-a990d8702b03
Wishlade, Tabitha
be399e13-e9b1-41e0-bafa-fadfda1917e3
Price, Helen
7871edf0-3516-41c6-b616-ad7cd74ec618
Fotaki, Eleni
0e684f01-f240-4146-b0f7-fb73529c8ec0
Vowles, Zoe
1a862f55-8b93-485c-8c3a-d9a4c94646e5
Lewin, Alice
9785fa0a-f803-44dc-aa50-cb9e0104b228
Tarft, Hayley
5526584c-8a96-48b5-a7c2-b61eca4c292b
Wade, Julie
c868ad51-2595-43ab-b304-aa7c499e25b7
Symington, Declan
8880dac0-db4f-4e38-b544-c6050e1bfbe4
Hunt, Jessamine
7021145f-901a-4f2b-bff6-0eed2a9ac5bb
Slaney, Maria
c1c1c400-5443-4d43-96d2-789663f8bce4
Mungeam, Charlotte
4b8aaf38-bcb3-4d92-8946-4a28e04c8cda
Khan, Rehan
0816f174-90f4-4471-b4fd-270e2d568448
Thomas, Amy
98b8e74c-7071-46e4-a7b5-cffbf516696d
Newman, Tabitha
06f76eb9-b243-4c3e-bd24-649f6fc4c635
Gouldbourne, Melanie
85d41d17-7f6d-4c4a-bb1e-43b3a382494d
Keen, Alexandra
b414156a-5c26-4211-a06f-1198fd0381f6
Rossi, Alice
dd40ce2c-d715-4e47-8fa9-7ce7976b2086
Maseko, Zandile
1bb02686-5d0d-4be5-bf8d-2d5958c63f0c
Churchill, David
804c50e9-80fa-4a05-a2ad-dc97ec44d69e
Devison, Laura
86166545-1bb5-4742-ac57-1f2f3b118036
Brooks, Kayleigh
e1e31318-336e-43b5-ac62-367cc7949cd1
Icke, Julia
bc3963f3-33f8-42b4-b509-b23d47162ad1
Bose, Patrick
cceec8f9-4486-4c40-95b4-8e042c5849d3
Lee, Fidelma
1f341fae-a78c-4bc9-8e79-4a92614f10b5
Scanlon, Suzanne
2a442e43-a25d-415e-a278-6385d09f7fe9
Girling, Joanna
3eb2e14b-17a4-40fb-a9e4-88743fa3e7d9
Johnson, Mark
64135487-45a1-46a6-a34b-595143e3c9a6
Singh, Natasha
329b45ee-4a3c-481e-9e68-e4c3b5ca4f89
Martella, Carmela
047aba46-2d1b-4b81-ac05-b9d9ceee0d19
Adamson, Christine
c066bfc9-e4b8-4dae-bfe8-1a91ad5ac04b
Sogo Buaki, Maria
2891380c-856b-43c4-93cc-eb22025c2779
Beadle, Nikki
95cbfde6-3010-4ea8-8701-608d31a85c6c
Hickey, Harriet
6f062c3b-f15d-4841-a04b-0f11d3e236e7
Iriondo-coysh, Amanda
839b9c6c-c19f-41b1-a60c-d092fd4620e7
Chilvers, Joanna
49721339-a663-4cf5-8984-d083ed8540d4
Duncan, Daisy
91e59edc-bd3d-4f85-b6dc-96f2ab350b00
Bourke, Miriam
466fe484-3697-4c70-a561-71099ce8e290
Myers, Jenny
69aa74b3-27e8-4a1f-abbf-18efb02cdc62
Barry, Natalie
49a88e1a-5f88-480c-a03c-40fc8ffff5c1
Glossop, Heather
b4acbf92-cc4a-40ac-8ec9-dd0c11760f63
Farrant, Kimberley
c29e6d6c-611f-41f4-af03-a40022fbf4cd
Waters, Clare
3904f9d1-da8e-4816-baa4-855d51c53be6
Thamban, Sujatha
b7a78722-4fe5-4df7-98cd-86349f97c4d6
Jones, Prudence
686d216c-ef23-44f6-a028-fb79b8469f21
Felippe, Sophia
70bdba86-6530-48e5-92d4-1c7d1702b91e
Kametas, Nick
7cfbe935-c672-4254-9111-0113f93eb252
Kay, Polly
fa667a82-eca2-4ef0-b7aa-94c52bca65e2
Clark, Katherine
3ba501fa-e8e7-4d83-9870-dd7ef4c92b1d
Jarman, Rebecca
0fd9fa7d-642e-4002-8e75-94806406dec4
Snowball, Olivia
a22e14bb-615e-4787-910f-4753f74b029a
Martin, Hayley
97edfe1c-bc33-4a00-a6ff-3ae0e1a9a65f
Osakwe, Osaeloke
3f680c37-ffbf-4b83-883c-92f0fbea12cb
Tilley, Bernadette
6f1e608e-6f11-40c3-8f8b-76e21b4aa566
Barker, Any
3f3dc6ad-05f6-40cc-95ab-20c0a86c464c
Gonzalez, Raquel
bdf99b10-a5f1-4911-ae6e-ffe9c811e320
Khalil, Asma
93c83da8-a44d-4294-b4c2-be2e6bed0731
Robinson, Sophie
ca6f6393-f165-4a34-98a5-d90541c7b851
Canclini, Lisa
f2b42c75-08e7-4e2c-b481-391e67b1df36
Unwin, Rebecca
1ac7846d-7978-4fa3-8696-d045a8ec60aa
Morris, Katie
32342907-8b68-4908-82fc-8c0bd1012dc7
Mellers, Dianne
defeec53-a05f-4b85-b342-fd9a8a2274bc
Adams, Phern
cd12b1b5-b449-4e59-9cb3-743fb3344dc7
Brittain, Lesley
a7662da3-812c-4d1d-9544-df930f83c13b
Dann, Sohpie
ed112c93-6f65-4aba-8589-627358a097eb
O'hara, Chloe
d6bb6805-bda3-49b4-b0ef-f80f97edf7fd
Whitehouse, Diane
a2103a3d-47da-4d36-97a3-309c6d8364c4
Ajay, Bini
a18b6c93-8394-4ccb-a577-1da7b18f5d7b
Upson, Geraldine
092663bb-1a39-4424-b7fa-c105f950a0ad
O'donnell, Hannah
a2374b37-6fbb-4111-afdb-d87a252b53ce
Zammit-mangion, Maria
13a33bf3-db1a-402b-afb0-7240f87b9b13
Tebbutt, Julie
a5348447-4319-4e5b-ad2d-b647e33e64e7
Frankland, Lisa
3f2d0c3c-3e21-4f4f-af10-45382043e067
Thornton, Danielle
174d7f96-5fac-4e3a-831e-b4b8a3361669
Sexton, Kristina
b0d2ef18-285b-472e-9512-1ace6944e987
Crowe, Rebecca
14efdf07-8b89-44b3-b534-4405a8c66bd5
Bowers, Amy
b788b213-1220-487c-b282-c6ca3329cd06
Winterbottom, Joanne
e13ebb64-c927-4d9e-8f58-a3db9cc599b5
Chappell, Lucy C.
775968ae-30c1-4084-beb0-11de8c90d611
Tucker, Katherine L.
990b0f31-7275-4261-8917-33b6e3002db0
Galal, Ushma
0148bc60-aabf-4e18-a3cf-5a39d255c63a
Yu, Ly-mee
849f372f-1a44-4941-af2e-0f4d0814fe86
Campbell, Helen
b776b7ea-8f26-4a57-9a17-35ef8b434497
Rivero-arias, Oliver
cd7dc5a8-d0b5-4dbd-a752-21ed6bad9b78
Allen, Julie
e974f668-2d71-467e-b3bd-3063f778ff53
Band, Rebecca
be8901bb-bb1b-4131-8e19-c1d4a3bdfb8d
Chisholm, Alison
b9c6e5d9-a4f3-4d05-aaa4-a1435fdc7771
Crawford, Carole
0e0d6662-b51a-41b1-8b2c-b33b1dd612c4
Dougall, Greig
61c47885-7736-40c9-a214-2fa895c8b382
Engonidou, Lazarina
23ca67fd-4063-47bd-b717-09d55d036d0b
Franssen, Marloes
299bcf45-0f42-4857-9d79-c4e4ce5c62cb
Green, Marcus
c28e0886-52a6-4926-aeb0-07c49760d7a9
Greenfield, Sheila
a983610e-aa36-442b-9f11-9af5721d7542
Hinton, Lisa
b260bc3f-3ecd-4202-b52a-6d606a6b3b92
Hodgkinson, James
1a369cb0-a81f-4af5-9b94-1d49e2f50a41
Lavallee, Layla
8c7676f3-697b-41b8-a56b-e570c340b3e4
Leeson, Paul
34dc217d-32e6-4c63-bcbb-334844939c92
Mccourt, Christine
597a251a-8e9d-4e38-9ce7-0b672603017a
Mackillop, Lucy
1c89c5c7-390b-4fcb-a941-7b94418bc0a5
Sandall, Jane
76109d47-f08b-480e-8c43-f2c18d7a1feb
Santos, Mauro
dd6fbde2-f0da-42f1-8ffd-96222d8038ba
Tarassenko, Lionel
2fc74dff-9b06-410f-92f5-63f2270a091c
Velardo, Carmelo
57266feb-8387-43c7-9d98-df28971f0e03
Wilson, Hannah
316ddb2e-6b57-45c7-9183-09520099f5ec
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Mcmanus, Richard J.
481f6284-d599-4c77-8869-d1c6b63b9b02
Cook, Johanna
2eb21e4e-2058-49ce-99a2-262d438bf988
Coates, Maria
4bece266-f962-40a0-8289-cfa22c3a9d1c
Gabriel, Thomas
bfe8de7c-4293-4f2a-ba7e-8f6898f5cbb7
Brann, Stephanie
90dbd09b-c441-4199-82b8-394d68921c12
De Henau, Joris
5ccf6331-910a-4613-a108-73fb36e4d587
Kelly, Sadie
00c2d18c-403a-41f2-a83d-007e0f7cb7b8
Watt, Dave
f31e1f83-b0d8-4fc9-a4ce-57385c52b839
Judge, David
66734c4b-626c-4609-95c6-a9e008a07f95
Castello, Luis
165d643a-0f5d-452c-a47c-a990d8702b03
Wishlade, Tabitha
be399e13-e9b1-41e0-bafa-fadfda1917e3
Price, Helen
7871edf0-3516-41c6-b616-ad7cd74ec618
Fotaki, Eleni
0e684f01-f240-4146-b0f7-fb73529c8ec0
Vowles, Zoe
1a862f55-8b93-485c-8c3a-d9a4c94646e5
Lewin, Alice
9785fa0a-f803-44dc-aa50-cb9e0104b228
Tarft, Hayley
5526584c-8a96-48b5-a7c2-b61eca4c292b
Wade, Julie
c868ad51-2595-43ab-b304-aa7c499e25b7
Symington, Declan
8880dac0-db4f-4e38-b544-c6050e1bfbe4
Hunt, Jessamine
7021145f-901a-4f2b-bff6-0eed2a9ac5bb
Slaney, Maria
c1c1c400-5443-4d43-96d2-789663f8bce4
Mungeam, Charlotte
4b8aaf38-bcb3-4d92-8946-4a28e04c8cda
Khan, Rehan
0816f174-90f4-4471-b4fd-270e2d568448
Thomas, Amy
98b8e74c-7071-46e4-a7b5-cffbf516696d
Newman, Tabitha
06f76eb9-b243-4c3e-bd24-649f6fc4c635
Gouldbourne, Melanie
85d41d17-7f6d-4c4a-bb1e-43b3a382494d
Keen, Alexandra
b414156a-5c26-4211-a06f-1198fd0381f6
Rossi, Alice
dd40ce2c-d715-4e47-8fa9-7ce7976b2086
Maseko, Zandile
1bb02686-5d0d-4be5-bf8d-2d5958c63f0c
Churchill, David
804c50e9-80fa-4a05-a2ad-dc97ec44d69e
Devison, Laura
86166545-1bb5-4742-ac57-1f2f3b118036
Brooks, Kayleigh
e1e31318-336e-43b5-ac62-367cc7949cd1
Icke, Julia
bc3963f3-33f8-42b4-b509-b23d47162ad1
Bose, Patrick
cceec8f9-4486-4c40-95b4-8e042c5849d3
Lee, Fidelma
1f341fae-a78c-4bc9-8e79-4a92614f10b5
Scanlon, Suzanne
2a442e43-a25d-415e-a278-6385d09f7fe9
Girling, Joanna
3eb2e14b-17a4-40fb-a9e4-88743fa3e7d9
Johnson, Mark
64135487-45a1-46a6-a34b-595143e3c9a6
Singh, Natasha
329b45ee-4a3c-481e-9e68-e4c3b5ca4f89
Martella, Carmela
047aba46-2d1b-4b81-ac05-b9d9ceee0d19
Adamson, Christine
c066bfc9-e4b8-4dae-bfe8-1a91ad5ac04b
Sogo Buaki, Maria
2891380c-856b-43c4-93cc-eb22025c2779
Beadle, Nikki
95cbfde6-3010-4ea8-8701-608d31a85c6c
Hickey, Harriet
6f062c3b-f15d-4841-a04b-0f11d3e236e7
Iriondo-coysh, Amanda
839b9c6c-c19f-41b1-a60c-d092fd4620e7
Chilvers, Joanna
49721339-a663-4cf5-8984-d083ed8540d4
Duncan, Daisy
91e59edc-bd3d-4f85-b6dc-96f2ab350b00
Bourke, Miriam
466fe484-3697-4c70-a561-71099ce8e290
Myers, Jenny
69aa74b3-27e8-4a1f-abbf-18efb02cdc62
Barry, Natalie
49a88e1a-5f88-480c-a03c-40fc8ffff5c1
Glossop, Heather
b4acbf92-cc4a-40ac-8ec9-dd0c11760f63
Farrant, Kimberley
c29e6d6c-611f-41f4-af03-a40022fbf4cd
Waters, Clare
3904f9d1-da8e-4816-baa4-855d51c53be6
Thamban, Sujatha
b7a78722-4fe5-4df7-98cd-86349f97c4d6
Jones, Prudence
686d216c-ef23-44f6-a028-fb79b8469f21
Felippe, Sophia
70bdba86-6530-48e5-92d4-1c7d1702b91e
Kametas, Nick
7cfbe935-c672-4254-9111-0113f93eb252
Kay, Polly
fa667a82-eca2-4ef0-b7aa-94c52bca65e2
Clark, Katherine
3ba501fa-e8e7-4d83-9870-dd7ef4c92b1d
Jarman, Rebecca
0fd9fa7d-642e-4002-8e75-94806406dec4
Snowball, Olivia
a22e14bb-615e-4787-910f-4753f74b029a
Martin, Hayley
97edfe1c-bc33-4a00-a6ff-3ae0e1a9a65f
Osakwe, Osaeloke
3f680c37-ffbf-4b83-883c-92f0fbea12cb
Tilley, Bernadette
6f1e608e-6f11-40c3-8f8b-76e21b4aa566
Barker, Any
3f3dc6ad-05f6-40cc-95ab-20c0a86c464c
Gonzalez, Raquel
bdf99b10-a5f1-4911-ae6e-ffe9c811e320
Khalil, Asma
93c83da8-a44d-4294-b4c2-be2e6bed0731
Robinson, Sophie
ca6f6393-f165-4a34-98a5-d90541c7b851
Canclini, Lisa
f2b42c75-08e7-4e2c-b481-391e67b1df36
Unwin, Rebecca
1ac7846d-7978-4fa3-8696-d045a8ec60aa
Morris, Katie
32342907-8b68-4908-82fc-8c0bd1012dc7
Mellers, Dianne
defeec53-a05f-4b85-b342-fd9a8a2274bc
Adams, Phern
cd12b1b5-b449-4e59-9cb3-743fb3344dc7
Brittain, Lesley
a7662da3-812c-4d1d-9544-df930f83c13b
Dann, Sohpie
ed112c93-6f65-4aba-8589-627358a097eb
O'hara, Chloe
d6bb6805-bda3-49b4-b0ef-f80f97edf7fd
Whitehouse, Diane
a2103a3d-47da-4d36-97a3-309c6d8364c4
Ajay, Bini
a18b6c93-8394-4ccb-a577-1da7b18f5d7b
Upson, Geraldine
092663bb-1a39-4424-b7fa-c105f950a0ad
O'donnell, Hannah
a2374b37-6fbb-4111-afdb-d87a252b53ce
Zammit-mangion, Maria
13a33bf3-db1a-402b-afb0-7240f87b9b13
Tebbutt, Julie
a5348447-4319-4e5b-ad2d-b647e33e64e7
Frankland, Lisa
3f2d0c3c-3e21-4f4f-af10-45382043e067
Thornton, Danielle
174d7f96-5fac-4e3a-831e-b4b8a3361669
Sexton, Kristina
b0d2ef18-285b-472e-9512-1ace6944e987
Crowe, Rebecca
14efdf07-8b89-44b3-b534-4405a8c66bd5
Bowers, Amy
b788b213-1220-487c-b282-c6ca3329cd06
Winterbottom, Joanne
e13ebb64-c927-4d9e-8f58-a3db9cc599b5

Chappell, Lucy C., Tucker, Katherine L., Galal, Ushma, Yu, Ly-mee, Campbell, Helen, Rivero-arias, Oliver, Allen, Julie, Band, Rebecca, Chisholm, Alison, Crawford, Carole, Dougall, Greig, Engonidou, Lazarina, Franssen, Marloes, Green, Marcus, Greenfield, Sheila, Hinton, Lisa, Hodgkinson, James, Lavallee, Layla, Leeson, Paul, Mccourt, Christine, Mackillop, Lucy, Sandall, Jane, Santos, Mauro, Tarassenko, Lionel, Velardo, Carmelo, Wilson, Hannah, Yardley, Lucy, Mcmanus, Richard J., Cook, Johanna, Coates, Maria, Gabriel, Thomas, Brann, Stephanie, De Henau, Joris, Kelly, Sadie, Watt, Dave, Judge, David, Castello, Luis, Wishlade, Tabitha, Price, Helen, Fotaki, Eleni, Vowles, Zoe, Lewin, Alice, Tarft, Hayley, Wade, Julie, Symington, Declan, Hunt, Jessamine, Slaney, Maria, Mungeam, Charlotte, Khan, Rehan, Thomas, Amy, Newman, Tabitha, Gouldbourne, Melanie, Keen, Alexandra, Rossi, Alice, Maseko, Zandile, Churchill, David, Devison, Laura, Brooks, Kayleigh, Icke, Julia, Bose, Patrick, Lee, Fidelma, Scanlon, Suzanne, Girling, Joanna, Johnson, Mark, Singh, Natasha, Martella, Carmela, Adamson, Christine, Sogo Buaki, Maria, Beadle, Nikki, Hickey, Harriet, Iriondo-coysh, Amanda, Chilvers, Joanna, Duncan, Daisy, Bourke, Miriam, Myers, Jenny, Barry, Natalie, Glossop, Heather, Farrant, Kimberley, Waters, Clare, Thamban, Sujatha, Jones, Prudence, Felippe, Sophia, Kametas, Nick, Kay, Polly, Clark, Katherine, Jarman, Rebecca, Snowball, Olivia, Martin, Hayley, Osakwe, Osaeloke, Tilley, Bernadette, Barker, Any, Gonzalez, Raquel, Khalil, Asma, Robinson, Sophie, Canclini, Lisa, Unwin, Rebecca, Morris, Katie, Mellers, Dianne, Adams, Phern, Brittain, Lesley, Dann, Sohpie, O'hara, Chloe, Whitehouse, Diane, Ajay, Bini, Upson, Geraldine, O'donnell, Hannah, Zammit-mangion, Maria, Tebbutt, Julie, Frankland, Lisa, Thornton, Danielle, Sexton, Kristina, Crowe, Rebecca, Bowers, Amy and Winterbottom, Joanne (2022) Effect of self-monitoring of blood pressure on blood pressure control in pregnant individuals with chronic or gestational hypertension: the BUMP 2 randomized clinical trial. JAMA, 327 (17), 1666-1678. (doi:10.1001/jama.2022.4726).

Record type: Article

Abstract

Importance: inadequate management of elevated blood pressure is a significant contributing factor to maternal deaths. The role of blood pressure self-monitoring in pregnancy in improving clinical outcomes for the pregnant individual and infant is unclear. Objective: To evaluate the effect of blood pressure self-monitoring, compared with usual care alone, on blood pressure control and other related maternal and infant outcomes, in individuals with pregnancy hypertension. 

Design, setting, and participants: unblinded, randomized clinical trial that recruited between November 2018 and September 2019 in 15 hospital maternity units in England. Individuals with chronic hypertension (enrolled up to 37 weeks' gestation) or with gestational hypertension (enrolled between 20 and 37 weeks' gestation). Final follow-up was in May 2020. Interventions: Participants were randomized to either blood pressure self-monitoring using a validated monitor and a secure telemonitoring system in addition to usual care (n = 430) or to usual care alone (n = 420). Usual care comprised blood pressure measured by health care professionals at regular antenatal clinics. 

Main outcomes and measures: the primary maternal outcome was the difference in mean systolic blood pressure recorded by health care professionals between randomization and birth. Results: Among 454 participants with chronic hypertension (mean age, 36 years; mean gestation at entry, 20 weeks) and 396 with gestational hypertension (mean age, 34 years; mean gestation at entry, 33 weeks) who were randomized, primary outcome data were available from 444 (97.8%) and 377 (95.2%), respectively. In the chronic hypertension cohort, there was no statistically significant difference in mean systolic blood pressure for the self-monitoring groups vs the usual care group (133.8 mm Hg vs 133.6 mm Hg, respectively; adjusted mean difference, 0.03 mm Hg [95% CI, -1.73 to 1.79]). In the gestational hypertension cohort, there was also no significant difference in mean systolic blood pressure (137.6 mm Hg compared with 137.2 mm Hg; adjusted mean difference, -0.03 mm Hg [95% CI, -2.29 to 2.24]). There were 8 serious adverse events in the self-monitoring group (4 in each cohort) and 3 in the usual care group (2 in the chronic hypertension cohort and 1 in the gestational hypertension cohort). 

Conclusions andrelevance: among pregnant individuals with chronic or gestational hypertension, blood pressure self-monitoring with telemonitoring, compared with usual care, did not lead to significantly improved clinic-based blood pressure control. Trial Registration: ClinicalTrials.gov Identifier: NCT03334149.

Text
Effect of Self-monitoring of Blood Pressure on Blood Pressure - Accepted Manuscript
Download (12MB)

More information

e-pub ahead of print date: 3 May 2022
Additional Information: Funding Information: reported receiving personal fees from Sensyne Health Group outside the submitted work; in addition, Dr Santos had a patent for University of Oxford Innovation Project 17725, BUMP– Technology License licensed to Sensyne Health Group. Dr Tarassenko reported receiving grants and personal fees (as a nonexecutive director and director of research and development) from Sensyne Health outside the submitted work. Dr Velardo reported being a full-time employee of Sensyne Health outside the submitted work; in addition, Dr Velardo had a patent for the University of Oxford Innovation Project 17725, BUMP– Technology License licensed to Sensyne Health Group. Dr McManus reported receiving other from Sensyne (the BUMP intervention was licensed by the University of Oxford for free during the COVID-19 pandemic and the university has received fees subsequently) during the conduct of the study and nonfinancial support from Omron (Omron licensed and paid consultancy to the University of Oxford with regard to a telemonitoring intervention developed with his help, and previously supplied blood pressure monitors for TASMINH4 study) and grants from the National Institute for Health Research (NIHR) outside the submitted work; and occasional travel and accommodation for speaking at conferences (any honoraria are paid to his institution). No other disclosures were reported. Funding Information: Funding/Support: This work was funded from a Publisher Copyright: © 2022 American Medical Association. All rights reserved.

Identifiers

Local EPrints ID: 457949
URI: http://eprints.soton.ac.uk/id/eprint/457949
ISSN: 0098-7484
PURE UUID: adab48dd-bc64-45e7-b45a-abc2213d5a70
ORCID for Rebecca Band: ORCID iD orcid.org/0000-0001-5403-1708
ORCID for Lucy Yardley: ORCID iD orcid.org/0000-0002-3853-883X

Catalogue record

Date deposited: 23 Jun 2022 17:12
Last modified: 03 Nov 2022 05:01

Export record

Altmetrics

Contributors

Author: Lucy C. Chappell
Author: Katherine L. Tucker
Author: Ushma Galal
Author: Ly-mee Yu
Author: Helen Campbell
Author: Oliver Rivero-arias
Author: Julie Allen
Author: Rebecca Band ORCID iD
Author: Alison Chisholm
Author: Carole Crawford
Author: Greig Dougall
Author: Lazarina Engonidou
Author: Marloes Franssen
Author: Marcus Green
Author: Sheila Greenfield
Author: Lisa Hinton
Author: James Hodgkinson
Author: Layla Lavallee
Author: Paul Leeson
Author: Christine Mccourt
Author: Lucy Mackillop
Author: Jane Sandall
Author: Mauro Santos
Author: Lionel Tarassenko
Author: Carmelo Velardo
Author: Hannah Wilson
Author: Lucy Yardley ORCID iD
Author: Richard J. Mcmanus
Author: Johanna Cook
Author: Maria Coates
Author: Thomas Gabriel
Author: Stephanie Brann
Author: Joris De Henau
Author: Sadie Kelly
Author: Dave Watt
Author: David Judge
Author: Luis Castello
Author: Tabitha Wishlade
Author: Helen Price
Author: Eleni Fotaki
Author: Zoe Vowles
Author: Alice Lewin
Author: Hayley Tarft
Author: Julie Wade
Author: Declan Symington
Author: Jessamine Hunt
Author: Maria Slaney
Author: Charlotte Mungeam
Author: Rehan Khan
Author: Amy Thomas
Author: Tabitha Newman
Author: Melanie Gouldbourne
Author: Alexandra Keen
Author: Alice Rossi
Author: Zandile Maseko
Author: David Churchill
Author: Laura Devison
Author: Kayleigh Brooks
Author: Julia Icke
Author: Patrick Bose
Author: Fidelma Lee
Author: Suzanne Scanlon
Author: Joanna Girling
Author: Mark Johnson
Author: Natasha Singh
Author: Carmela Martella
Author: Christine Adamson
Author: Maria Sogo Buaki
Author: Nikki Beadle
Author: Harriet Hickey
Author: Amanda Iriondo-coysh
Author: Joanna Chilvers
Author: Daisy Duncan
Author: Miriam Bourke
Author: Jenny Myers
Author: Natalie Barry
Author: Heather Glossop
Author: Kimberley Farrant
Author: Clare Waters
Author: Sujatha Thamban
Author: Prudence Jones
Author: Sophia Felippe
Author: Nick Kametas
Author: Polly Kay
Author: Katherine Clark
Author: Rebecca Jarman
Author: Olivia Snowball
Author: Hayley Martin
Author: Osaeloke Osakwe
Author: Bernadette Tilley
Author: Any Barker
Author: Raquel Gonzalez
Author: Asma Khalil
Author: Sophie Robinson
Author: Lisa Canclini
Author: Rebecca Unwin
Author: Katie Morris
Author: Dianne Mellers
Author: Phern Adams
Author: Lesley Brittain
Author: Sohpie Dann
Author: Chloe O'hara
Author: Diane Whitehouse
Author: Bini Ajay
Author: Geraldine Upson
Author: Hannah O'donnell
Author: Maria Zammit-mangion
Author: Julie Tebbutt
Author: Lisa Frankland
Author: Danielle Thornton
Author: Kristina Sexton
Author: Rebecca Crowe
Author: Amy Bowers
Author: Joanne Winterbottom

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×