A health coaching intervention may improve blood pressure control in postpartum women

1. A health coaching intervention combined with self-measured blood pressure (SMBP) monitoring for postpartum women was associated with significantly greater engagement with primary care and significantly greater reductions in systolic and diastolic blood pressure (BP).

Evidence Rating Level: 1 (Excellent)

Hypertensive disorders of pregnancy (HDP) affect up to 16% of pregnancies in the United States and are associated with increased rates of chronic hypertension, heart failure, and cardiovascular death. HDP can occur in the postpartum period, where frequent follow-up is essential for better BP control. However, multiple barriers to follow-up exist, with some trials showing up to 30% of postpartum patients having unresolved hypertension. SMBP monitoring with health coaching has been shown to be an effective, at-home intervention to manage hypertension and support behaviour change. This study adapted a hypertension coaching intervention to create the Staying Healthy After Childbirth–My Hypertension Education And Reaching Target Postpartum (STAC–MyHEARTp; hereafter, STAC). STAC was a 6-week remote program that provided a home BP monitor, training on how to measure BP at home, daily SMBP monitoring, and surveillance and treatment. 140 postpartum women diagnosed with HDP were recruited and randomized to receive STAC (n = 70; mean [SD] age, 33.3 [5.1] years) or standard of care (n = 70; mean [SD] age, 33.4 [5.0] years). 29 (41.1%) and 29 (41.1%) patients had chronic hypertension, 25 (35.7%) and 22 (31.4%) patients had gestational hypertension, 6 (8.6%) and 6 (8.6%) patients had mild preeclampsia, and 10 (14.3%) and 13 (18.6%) patients had severe preeclampsia in the intervention and control groups, respectively. At the time of enrollment, 40 (57.1%) participants in the intervention group and 44 (63.8%) in the control group were using an antihypertensive medication. Primary care visit attendance was significantly higher in the intervention group than the control group (49 of 69 [71.0%] vs 27 of 69 [39.1%]; relative risk [RR], 2.00 [95% CI, 1.34-2.97], P < .001). At 12 months postpartum, the intervention significantly reduced systolic BP (mean difference, −5.6 [95% CI, −9.4 to −1.7] mm Hg, P = .005) and diastolic BP (mean difference, −4.5 [95% CI, −7.7 to −1.3] mm Hg, P = .006) compared to control. BP control (<130/80 mm Hg) was also significantly more likely with the intervention group (26 of 47 [55.3%] vs 19 of 61 [31.1%]; RR, 1.73 [95% CI, 1.13-2.66]; P = .02).

Click here to read this study in JAMA Network Open

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