(674) Postpartum Home Blood Pressure Monitoring: Impact on Post-Discharge Morbidity Among Individuals on Antihypertensive Medication

To evaluate the impact of Postpartum Hypertension Program (PHP) implementation on morbidity following delivery discharge among individuals on antihypertensive medication.

Study Design:
This was a prospective cohort study of individuals who delivered at a quaternary care center and were discharged on antihypertensive medication. P</span>re-implementation controls (delivery discharge 1/1/21–1/20/24) were compared to p<span style="font-size: 12.0pt; line-height: 115%; font-family: 'Aptos',sans-serif; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: Aptos; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: minor-bidi; color: #211e1e; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">ost-implementation cases (delivery discharge 3/21/24–3/31/25). The PHP included 1) twice-daily home blood pressure (BP) monitoring and 2) MD-guided antihypertensive titration for 2 weeks post-discharge. The primary outcome was a composite of new-onset morbidity within 30 days of discharge, including preeclampsia lab abnormalities, HELLP syndrome, eclampsia, pulmonary edema/acute heart failure, cerebrovascular disorders, myocardial infarction/cardiac arrest, liver hematoma, acute renal failure and ICU admission. Secondary outcomes included hospital return within 30 days of discharge, hospital return length of stay, and maximum BP during hospital return. Bivariate analysis compared cases and controls using chi-square and t-test as appropriate.

Results:

Of 717 eligible individuals, there were 218 cases and 468 controls. Cases were more likely to be diagnosed with gestational hypertension, less likely to be diagnosed with severe preeclampsia, and had lower systolic BP in the 24 hours prior to delivery discharge (Table 1). PHP implementation was associated with a reduction in post-discharge morbidity (0% vs 1.9%, p= 0.04), driven by lower rates of new-onset pulmonary edema/acute heart failure and preeclampsia lab abnormalities. There was no difference in rate of hospital return between cases and controls (5.1% vs 4.9%, p=0.94) (Table 2). Remaining secondary outcomes were similar between groups.

Conclusion:
Among individuals on antihypertensive medication, PHP implementation was associated with a significant reduction in post-discharge morbidity. This finding was driven by lower rates of new-onset pulmonary edema/acute heart failure and preeclampsia lab abnormalities.