Telehealth and Remote Blood Pressure

Hypertension (HTN) in pregnancy requires weekly or bi-weekly in-person visits. Telehealth visits with remote blood pressure (BP) telemonitoring may be an alternative to frequent in-person visits improve adherence. However, the feasibility of this approach in pregnancy is lacking and studies are limited on the use of remote BP telemonitoring in chronic HTN (cHTN) during pregnancy. A digital health platform for BP management in pregnant women at risk for preeclampsia (women with cHTN, prior preeclampsia or kidney disease) found fewer admissions for HTN or suspected preeclampsia in the intervention compared to usual care. There is a critical need to investigate the feasibility (willingness and adherence), and safety of this intervention. Without ascertaining the feasibility of telehealth and remote BP monitoring, it remains a challenge to tackle the no-show rates and suboptimal medication adherence during pregnancy.

Objectives Aim 1: To determine the feasibility of incorporating telehealth clinic visits with remote BP telemonitoring alternating with in-person clinic visits in the management of cHTN in pregnancy in the clinic by evaluating willingness to enroll, completion rate and adherence versus standard care (in-person clinic visits alone). This working hypothesis is that this approach will be as feasible as standard care.

Aim 2: To explore safety outcomes of telehealth clinic visits combined with blood pressure remote telemonitoring alternating with in-person clinic visits in the management of chronic hypertension in pregnant patients in the clinic by measuring the incidence of hypotension, syncope or hospitalization/emergency room visits for severe HTN compared to standard care. The working hypothesis is that this approach will be comparable in safety to standard care.

Inclusion criteria

• prior diagnosis of Chronic hypertension (cHTN)
• Pregnant women
• Known: documented diagnosis or on antihypertensive medication prior to pregnancy

Exclusion criteria

• Any significant chronic medical or psychiatric illness that, in the investigator's opinion, would prevent participation in the study
• Cardiac disorders: cardiomyopathy, angina, Coronary Artery Disease (CAD)
• Current substance abuse disorder
• Multifetal pregnancy
• Participation in another study without prior approval
• Plan to deliver outside Atrium Health Wake Forest Baptist
• Prior stroke
• Severe hypertension
• Suspected or known fetal major structural/chromosomal abnormality or fetal demise