Dr Zhuo Lin Ng1, Professor Angela Makris1,2,3, Dr Renuka Shanmugalingam1,2,3
1Liverpool Hospital Department of Renal Medicine, Sydney, Australia, 2School of Medicine, Western Sydney University, Sydney, Australia, 3South West Sydney Clinical School, University of New South Wales, Sydney, Australia
Biography:
Dr Zhuo Lin Ng (Jolene) is a nephrology fellow who is currently pursuing an obstetric medicine fellowship / SOMANZ certification in Brisbane, QLD Australia.
Abstract:
Background: The utility of home blood pressure monitoring (HBPM) as a monitoring tool in the general population has been increasingly examined in recent years. Increasing reports of improved diagnostic accuracy, increased monitoring frequency and reduced patient attendances have demonstrated that HBPM can be an effective alternative to clinical blood pressure monitoring in the pregnant population.
Methods:
An electronic database search with predetermined MeSH keywords for studies published between January 1970 and December 2022 was conducted. Search output was examined by two independent reviewers who selected studies through a two-step review process with predetermined inclusion and exclusion criteria. With the final selection of studies, randomized controlled trials were prioritized. Data extraction of selected studies were conducted and analyzed through Review Manager 5.4.1. Outcomes of the meta-analyses were reported as Relative Ratios (RR). Quality of evidence were analyzed through the GRADE assessment and risk of bias assessments were conducted through the Revised Cochrane risk-of-bias tool for randomized trials (RoB 2).
Results: Four RCTs were included in this systematic review. Meta-analyses of 3,533 women with hypertensive disorders of pregnancy (HDP) showed no statistically significant difference in the rates of preeclampsia, total adverse maternal outcomes, severe hypertension (≥160/100mmHg) events, emergency delivery indicated for hypertension, stillbirth, preterm delivery (<34 weeks), small for gestation age and neonatal mortality between the HBPM and clinical blood pressure monitoring groups. There was, however, reduced frequency of antenatal visits (4.5 vs 7.4 visits, P < 0.00001), and an increased frequency of blood pressure measurements (in weeks) (10 vs 6.9 weeks, P < 0.00001) in the HBPM group.
Conclusions: Home blood pressure monitoring in women with HDP may be an acceptable alternative to conventional clinic-based blood pressure monitoring. Our review showed that HBPM compared to clinical blood pressure monitoring, did not lead to increased rates of adverse maternal or fetal outcomes.
Keywords
preeclampsia, hypertension
References
1. Khedagi AM, Bello NA. Hypertensive Disorders of Pregnancy. Cardiol Clin. 2021 Feb; 39(1):77-90.
2. Wu P, Green M, Myers J E. Hypertensive disorders of pregnancy BMJ 2023.
3. Society of Obstetric Medicine Australia and New Zealand, Hypertension in Pregnancy Guideline, Sydney; 2023. (In Press)