Effect of Self-monitoring of Blood Pressure on Diagnosis of Hypertension During Higher-Risk Pregnancy: The BUMP 1 Randomized Clinical Trial.

Tucker, KL; Mort, S; Yu, L-M; Campbell, H; Rivero-Arias, O; Wilson, HM; Allen, J; Band, R; Chisholm, A; Crawford, C; Dougall, G; Engonidou, L; Franssen, M; Green, M; Greenfield, S; Hinton, L; Hodgkinson, J; Lavallee, L; Leeson, P; McCourt, C; Mackillop, L; Sandall, J; Santos, M; Tarassenko, L; Velardo, C; Yardley, L; Chappell, LC; McManus, RJ; BUMP Investigators,

Effect of Self-monitoring of Blood Pressure on Diagnosis of Hypertension During Higher-Risk Pregnancy: The BUMP 1 Randomized Clinical Trial.

Tucker, KL Mort, S Yu, L-M Campbell, H Rivero-Arias, O Wilson, HM Allen, J Band, R Chisholm, A Crawford, C Dougall, G Engonidou, L Franssen, M Green, M Greenfield, S Hinton, L Hodgkinson, J Lavallee, L Leeson, P McCourt, C Mackillop, L Sandall, J

Santos, M Tarassenko, L Velardo, C Yardley, L Chappell, LC McManus, RJ BUMP Investigators,

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Publisher:: American Medical Association
Publication Type:: Journal Article
Citation:: JAMA: Journal of the American Medical Association, 2022, 327, (17), pp. 1656-1665
Issue Date:: 2022-05-03

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Field	Value	Language
dc.contributor.author	Tucker, KL
dc.contributor.author	Mort, S
dc.contributor.author	Yu, L-M
dc.contributor.author	Campbell, H
dc.contributor.author	Rivero-Arias, O
dc.contributor.author	Wilson, HM
dc.contributor.author	Allen, J
dc.contributor.author	Band, R
dc.contributor.author	Chisholm, A
dc.contributor.author	Crawford, C
dc.contributor.author	Dougall, G
dc.contributor.author	Engonidou, L
dc.contributor.author	Franssen, M
dc.contributor.author	Green, M
dc.contributor.author	Greenfield, S
dc.contributor.author	Hinton, L
dc.contributor.author	Hodgkinson, J
dc.contributor.author	Lavallee, L
dc.contributor.author	Leeson, P
dc.contributor.author	McCourt, C
dc.contributor.author	Mackillop, L
dc.contributor.author	Sandall, J https://orcid.org/0000-0003-2000-743X
dc.contributor.author	Santos, M
dc.contributor.author	Tarassenko, L
dc.contributor.author	Velardo, C
dc.contributor.author	Yardley, L
dc.contributor.author	Chappell, LC
dc.contributor.author	McManus, RJ
dc.contributor.author	BUMP Investigators,
dc.date.accessioned	2022-10-14T03:20:05Z
dc.date.available	2022-10-14T03:20:05Z
dc.date.issued	2022-05-03
dc.identifier.citation	JAMA: Journal of the American Medical Association, 2022, 327, (17), pp. 1656-1665
dc.identifier.issn	0098-7484
dc.identifier.issn	1538-3598
dc.identifier.uri	http://hdl.handle.net/10453/162599
dc.description.abstract	Importance: Inadequate management of elevated blood pressure (BP) is a significant contributing factor to maternal deaths. Self-monitoring of BP in the general population has been shown to improve the diagnosis and management of hypertension; however, little is known about its use in pregnancy. Objective: To determine whether self-monitoring of BP in higher-risk pregnancies leads to earlier detection of pregnancy hypertension. Design, Setting, and Participants: Unblinded, randomized clinical trial that included 2441 pregnant individuals at higher risk of preeclampsia and recruited at a mean of 20 weeks' gestation from 15 hospital maternity units in England between November 2018 and October 2019. Final follow-up was completed in April 2020. Interventions: Participating individuals were randomized to either BP self-monitoring with telemonitoring (n = 1223) plus usual care or usual antenatal care alone (n = 1218) without access to telemonitored BP. Main Outcomes and Measures: The primary outcome was time to first recorded hypertension measured by a health care professional. Results: Among 2441 participants who were randomized (mean [SD] age, 33 [5.6] years; mean gestation, 20 [1.6] weeks), 2346 (96%) completed the trial. The time from randomization to clinic recording of hypertension was not significantly different between individuals in the self-monitoring group (mean [SD], 104.3 [32.6] days) vs in the usual care group (mean [SD], 106.2 [32.0] days) (mean difference, -1.6 days [95% CI, -8.1 to 4.9]; P = .64). Eighteen serious adverse events were reported during the trial with none judged as related to the intervention (12 [1%] in the self-monitoring group vs 6 [0.5%] in the usual care group). Conclusions and Relevance: Among pregnant individuals at higher risk of preeclampsia, blood pressure self-monitoring with telemonitoring, compared with usual care, did not lead to significantly earlier clinic-based detection of hypertension. Trial Registration: ClinicalTrials.gov Identifier: NCT03334149.
dc.format	Print
dc.language	eng
dc.publisher	American Medical Association
dc.relation.ispartof	JAMA: Journal of the American Medical Association
dc.relation.isbasedon	10.1001/jama.2022.4712
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	11 Medical and Health Sciences
dc.subject.classification	General & Internal Medicine
dc.subject.mesh	Adult
dc.subject.mesh	Blood Pressure
dc.subject.mesh	Blood Pressure Monitoring, Ambulatory
dc.subject.mesh	Female
dc.subject.mesh	Humans
dc.subject.mesh	Hypertension
dc.subject.mesh	Hypertension, Pregnancy-Induced
dc.subject.mesh	Pre-Eclampsia
dc.subject.mesh	Pregnancy
dc.subject.mesh	Pregnancy, High-Risk
dc.subject.mesh	Self-Testing
dc.subject.mesh	Telemetry
dc.subject.mesh	Adult
dc.subject.mesh	Blood Pressure
dc.subject.mesh	Blood Pressure Monitoring, Ambulatory
dc.subject.mesh	Female
dc.subject.mesh	Humans
dc.subject.mesh	Hypertension
dc.subject.mesh	Hypertension, Pregnancy-Induced
dc.subject.mesh	Pre-Eclampsia
dc.subject.mesh	Pregnancy
dc.subject.mesh	Pregnancy, High-Risk
dc.subject.mesh	Self-Testing
dc.subject.mesh	Telemetry
dc.subject.mesh	Humans
dc.subject.mesh	Hypertension, Pregnancy-Induced
dc.subject.mesh	Pre-Eclampsia
dc.subject.mesh	Hypertension
dc.subject.mesh	Blood Pressure Monitoring, Ambulatory
dc.subject.mesh	Telemetry
dc.subject.mesh	Pregnancy
dc.subject.mesh	Pregnancy, High-Risk
dc.subject.mesh	Blood Pressure
dc.subject.mesh	Adult
dc.subject.mesh	Female
dc.subject.mesh	Self-Testing
dc.title	Effect of Self-monitoring of Blood Pressure on Diagnosis of Hypertension During Higher-Risk Pregnancy: The BUMP 1 Randomized Clinical Trial.
dc.type	Journal Article
utslib.citation.volume	327
utslib.location.activity	United States
utslib.for	11 Medical and Health Sciences
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Midwifery
utslib.copyright.status	closed_access	*
pubs.consider-herdc	false
dc.date.updated	2022-10-14T03:20:03Z
pubs.issue	17
pubs.publication-status	Published
pubs.volume	327
utslib.citation.issue	17

Abstract:

Importance: Inadequate management of elevated blood pressure (BP) is a significant contributing factor to maternal deaths. Self-monitoring of BP in the general population has been shown to improve the diagnosis and management of hypertension; however, little is known about its use in pregnancy. Objective: To determine whether self-monitoring of BP in higher-risk pregnancies leads to earlier detection of pregnancy hypertension. Design, Setting, and Participants: Unblinded, randomized clinical trial that included 2441 pregnant individuals at higher risk of preeclampsia and recruited at a mean of 20 weeks' gestation from 15 hospital maternity units in England between November 2018 and October 2019. Final follow-up was completed in April 2020. Interventions: Participating individuals were randomized to either BP self-monitoring with telemonitoring (n = 1223) plus usual care or usual antenatal care alone (n = 1218) without access to telemonitored BP. Main Outcomes and Measures: The primary outcome was time to first recorded hypertension measured by a health care professional. Results: Among 2441 participants who were randomized (mean [SD] age, 33 [5.6] years; mean gestation, 20 [1.6] weeks), 2346 (96%) completed the trial. The time from randomization to clinic recording of hypertension was not significantly different between individuals in the self-monitoring group (mean [SD], 104.3 [32.6] days) vs in the usual care group (mean [SD], 106.2 [32.0] days) (mean difference, -1.6 days [95% CI, -8.1 to 4.9]; P = .64). Eighteen serious adverse events were reported during the trial with none judged as related to the intervention (12 [1%] in the self-monitoring group vs 6 [0.5%] in the usual care group). Conclusions and Relevance: Among pregnant individuals at higher risk of preeclampsia, blood pressure self-monitoring with telemonitoring, compared with usual care, did not lead to significantly earlier clinic-based detection of hypertension. Trial Registration: ClinicalTrials.gov Identifier: NCT03334149.

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http://hdl.handle.net/10453/162599