Comparing standard office-based follow-up with text-based remote monitoring in the management of postpartum hypertension: a randomised clinical trial

BMJ Qual Saf. 2018 Nov;27(11):871-877. doi: 10.1136/bmjqs-2018-007837. Epub 2018 Apr 27.


Background: Monitoring blood pressure at 72 hours and 7-10 days post partum in women with hypertensive disorders is recommended to decrease morbidity. However, there are no recommendations as to how to achieve this.

Objective: To compare the effectiveness of text-based blood pressure monitoring to in-person visits for women with hypertensive disorders of pregnancy in the immediate postpartum period.

Methods: Randomised clinical trial among 206 postpartum women with pregnancy-related hypertension diagnosed during the delivery admission between August 2016 and January 2017. Women were randomised to 2 weeks of text-based surveillance using a home blood pressure cuff and previously tested automated platform or usual care blood pressure check at their prenatal clinic 4-6 days following discharge. The primary study outcome was a single recorded blood pressure in the first 10 days post partum. The ability to meet American Congress of Obstetricians and Gynecologists (ACOG) guidelines, defined as having a blood pressure recorded on postpartum days 3-4 and 7-10 was evaluated in the text message group. The study was powered to detect a 1.4-fold increase in a single recorded blood pressure using text messaging. All outcomes were analysed as intention to treat.

Results: 206 women were randomised (103 in each arm). Baseline characteristics were similar. There was a statistically significant increase in a single blood pressure obtained in the texting group in the first 10 days post partum as compared with the office group (92.2% vs 43.7%; adjusted OR 58.2 (16.2-208.1), p<0.001). Eighty-four per cent of patients undergoing text-based surveillance met ACOG criteria for blood pressures at both recommended points.

Conclusions: Text-based monitoring is more effective in obtaining blood pressures and meeting current clinical guidelines in the immediate postdischarge period in women with pregnancy-related hypertension compared with traditional office-based follow-up.

Trial registration number: NCT03185455, Remote Surveillance of Postpartum Hypertension (TextBP),

Keywords: healthcare quality improvement; obstetrics and gynaecology; patient-centred care.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Antihypertensive Agents / administration & dosage*
  • Blood Pressure Determination / methods
  • Blood Pressure Monitoring, Ambulatory / methods*
  • Confidence Intervals
  • Female
  • Follow-Up Studies
  • Humans
  • Hypertension, Pregnancy-Induced / diagnosis*
  • Hypertension, Pregnancy-Induced / drug therapy*
  • Odds Ratio
  • Office Visits
  • Postpartum Period
  • Pregnancy
  • Sensitivity and Specificity
  • Text Messaging / statistics & numerical data*
  • Treatment Outcome


  • Antihypertensive Agents

Associated data