Dr Sabina Freiman1, Dr Raveena Kapoor2, Dr Karen C Tran3
1General Internal Medicine Fellowship Program, University Of British Columbia, Vancouver, Canada, 2Internal Medicine Residency Program, University of British Columbia, Vancouver, Canada, 3Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada
Biography:
Dr. Sabina Freiman is a 5th year Fellow of General Internal Medicine at the University of British Columbia in Vancouver, Canada with a final year focus on Obstetric Medicine.
Abstract:
Background: Hypertensive disorders of pregnancy (HDP) have significant effects on maternal and fetal health. Post-partum hypertension is one of the leading causes of hospital readmissions and comprises 10% of hypertension-related maternal deaths. HDP are associated with increased cardiovascular risks, including increased chronic hypertension and dyslipidemia. This necessitates early detection, monitoring, and treatment of post-partum hypertension.
Traditionally, women with HDP are not seen until a clinic visit 4-6 weeks post-partum. There are several barriers that interfere with compliance to monitoring regimens in this period, including physical and time constraints. Research exploring socioeconomic factors such as race and age suggests that vulnerable populations are disproportionately impacted by post-partum hypertension, highlighting additional barriers they face. Alternative regimens for screening of blood pressure including remote monitoring have been explored. Recent studies have shown that home blood pressure (BP) monitoring can improve blood pressure control, with potential long-term reduction to BP readings even years later. The aim of our systematic review is to assess current patterns of practice of post-partum hypertension clinics.
Methods: We will conduct a systematic review of observational and randomized controlled trials in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. We will conduct a structured search of articles in the English language through MEDLINE (1946), Embase (1974), and CENTRAL databases 2018 through present. Studies assessing alternative models of care of post-partum hypertension compared to usual care will be evaluated. Outcomes include home BP targets for post-partum hypertension management, treatment thresholds for escalation and de-escalation of anti-hypertensive medications, subclinical vascular biomarkers (i.e.; 24h ambulatory blood pressure monitoring, echocardiogram, cardiac MRI and arterial stiffness), and patient acceptability.
Results: Will be available at the time of presentation and will help inform creation of evidence-based post-partum hypertension clinics.
Keywords
postpartum hypertension, home blood pressure monitoring, systematic review
References
1. Clapp MA, Little SE, Zheng J, Robinson JN. A multi-state analysis of postpartum readmissions in the United States. American journal of obstetrics and gynecology. 2016 Jul 1;215(1):113-e1.
2. Parekh N, Jarlenski M, Kelley D. Prenatal and postpartum care disparities in a large Medicaid program. Maternal and child health journal. 2018 Mar;22:429-37.
3. Cairns AE, Tucker KL, Leeson P, Mackillop LH, Santos M, Velardo C, Salvi D, Mort S, Mollison J, Tarassenko L, McManus RJ. Self-management of postnatal hypertension: the SNAP-HT trial. Hypertension. 2018 Aug;72(2):425-32.