This week, guest blogger Dr Asma Khalil explores how home blood pressure monitoring can provide safer, more personalised care for women who have pregnancy hypertension in the COVID-19 era and beyond.
COVID-19 has led to an abrupt transformation to virtual healthcare in pregnancy in an effort to reduce dependence on hospital-based care, and minimise the risk of pregnant women contracting the coronavirus during a routine hospital visit. The risk the infection poses is as great for pregnant women as it is for non-pregnant women, not least to the 10% of women who have pregnancy hypertension and require specialist hypertension care.
Guidance for care of pregnant women with hypertension has focused on provision of self-monitoring at home and virtual consultations when required. This is suitable for women with chronic or gestational hypertension and pre-eclampsia, who can self-monitor blood pressure and test urine protein at home with the readings remotely reviewed by the maternity-care team*.
Measuring blood pressure with a device validated for use in pregnancy
It isn’t the first time that at-home monitoring of blood pressure has been undertaken in maternity care, but the pandemic has led to a rapid implementation of this practice. Home blood pressure monitoring (HBPM) is a key part of a remote monitoring strategy in pregnancy and ideally suited to women with chronic hypertension, who may have practised this before pregnancy, and women with gestational hypertension or PET.
The UK is facilitating the use of HBPM in several ways. Firstly, the Royal College of Obstetricians and Gynaecologists (RCOG) provides guidance on blood pressure monitoring devices that are appropriate for home use and validated specifically for use in pregnancy and pre-eclampsia – along with clear patient instructions for blood pressure device loans and details of monitoring. Secondly, UK government agencies have procured and validated blood pressure monitors for purchase by hospitals, for at-home use by hypertensive pregnant women. Thirdly, use of blood pressure apps is being encouraged to facilitate recording of blood pressure and transmission of blood pressure values to care providers.
K2 Hampton is the only pregnancy blood pressure app certified as a Class-I medical device in the UK and has been extensively evaluated within the NHS. It enables women with hypertension to remotely enter blood pressure and urine protein results from home and work, prompting them to contact their midwife when they enter an out of range result. The results can be viewed by the clinician in real time at the hospital, highlighting results that require attention and allowing them to record actions required as a direct consequence. K2 Hampton blood pressure ranges default to the NICE cg107 guideline for hypertension in pregnancy. However, the clinician can also adapt these ranges individually for each woman to ensure that it is personalised for her needs.
Women at risk of high blood pressure are normally advised to attend hospital appointments two or three times per week for routine monitoring. Use of this app has been shown to reduce hospital visits by up to 50%, thereby reducing the risk of contracting COVID-19 during a routine appointment, while ensuring continued safe monitoring of blood pressure. Furthermore, an independent economic review found that K2 Hampton could save hospitals up to £966.97 per woman compared to traditional in-hospital monitoring*.
The pandemic has been a trying time but also rapidly broadened a shared model of care with women in order to diagnose and remotely manage pregnancy hypertension. As Winston Churchill said, ‘Never let a good crisis go to waste!’
*While it is possible for women with preeclampsia to be cared for as outpatients, it is of course still important for them to attend regular face-to-face appointments.