ABSTRACT
Objective: Prompt postpartum follow-up for women with hypertension is recommended. We hypothesized that use of home blood pressure monitoring may be beneficial to improve engagement. Our aim was to utilize home blood pressure monitoring with in-person and audio-only virtual visits in women with severe hypertension. Study Design: From March 2020 – September 2020 women with severe hypertension requiring oral antihypertensive therapy postpartum were provided a blood pressure cuff at time of hospital discharge and taught to take home measurements twice daily. Follow-up was scheduled within 10 days. Due to the COVID pandemic, audio-only virtual visits were prioritized, but left to the discretion of the discharge provider. Home blood pressure logs were reviewed at each encounter and documented in the medical record. Severe hypertension was defined as 160/110 mmHg or greater. Subsequent in-person or virtual visits were determined by the provider. Follow-up data and blood pressure values up to 6 weeks postpartum were retrospectively obtained. Statistical analysis included χ2 and McNemar’s test, with a P value <.05 considered significant. Results: Blood pressure cuffs were given to 206 women. Ten (5%) women on antihypertensive therapy represented to the hospital for hypertension. Ten women were lost to follow up after discharge from the hospital, leaving 196 women (95%) who presented for at least 1 postpartum visit. Systolic and diastolic values at the first visit were significantly lower at the last postpartum visit when compared to the first. Additionally, by the last postpartum visit, women were are on less blood pressure medications than at time of discharge from the hospital (P=.048). Composite blood pressure ranges above 140/90, 150/100, and 160/110 mmHg were significantly lower at the last visit when compared to the first, except for severe diastolic values (Figure 1). Conclusion: Use of audio-only virtual visits with in person follow-up for women with severe hypertension allowed for decreased oral antihypertensive medications and a reduction in blood pressure 140/90mmHg or greater. [Formula presented] [Formula presented]
ABSTRACT
Objective: Postpartum follow-up within 10 days is currently recommended for women with hypertension, though many women do not complete this visit. Methods beyond in-person visits may be necessary to achieve this. Our goal was to explore the use of home blood pressure monitoring with audio-only virtual visits and in-person postpartum visits for women with severe hypertension. Study Design: From March 2020 – September 2020 women with severe hypertension requiring oral antihypertensive therapy postpartum were provided a blood pressure cuff at time of hospital discharge and taught to take home measurements twice daily. Follow-up was scheduled within 10 days. Due to the COVID pandemic, audio-only virtual visits were prioritized, but left to the discretion of the discharge provider. Demographic and follow-up data up to six weeks postpartum were compiled retrospectively from the medical record. Severe hypertension was defined as blood pressure 160/110 mmHg or greater. Statistical analysis included χ2 and Student-t test, with P value <.05 considered significant. Results: Blood pressure cuffs were given to 206 women: 181 women with severe hypertension in the immediate postpartum period, and 25 who were re-admitted to the hospital with delayed-onset hypertension. Table 1 shows their demographics. Sixty-seven (32%) had pre-existing hypertension. There were 196 (95%) who had one postpartum visit, 165 (80%) had two visits. Average number of days to completion of follow-up appointment was 9 ± 6 days, with 146 (71%) following up at 10 days or less. Ten (5%) women did not return after discharge. Sixty-nine women had their first visit in-person, and 137 women had a virtual encounter. Virtual visits were more likely to be completed within 10 days (118/137 (86%) v 28/69 (41%), p<.001), and had less loss to follow-up after discharge (2/137 (1%) v 8/69 (12%), p<.001). Conclusion: In women with severe hypertension, follow-up within 10 days was more likely with audio-only virtual visits compared to clinic visits, offering an appropriate point of access to postpartum care. [Formula presented] [Formula presented]