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期刊来源：JAMA

文献发表时间：2023-11-11

原文链接：https://jamanetwork.com/journals/jama/article-abstract/2811976

关键点内容如下：

问题

在产后前9个月，使用支持蓝牙的应用程序进行远程自我监测和医生指导的抗高血压药物滴定是否比常规门诊护理提供更好的长期血压控制？

调查结果

在这项涉及220名参与者的随机临床试验中，高血压妊娠后，医生指导的门诊产后血压自我管理与产后9个月动态血压降低6/5-mm Hg相关。

意义

医生指导下的远程监护程序被用于指导血压的自我管理，与常规抗高血压治疗相比，该程序可改善高血压妊娠产后期间的血压控制。

摘要内容如下：

重要性

妊娠高血压综合征（妊高征）可导致不良的心脏重构，增加高血压和心血管疾病的发病率。

目的

评估旨在更好地控制产后血压的干预措施是否与产后前9个月的血压低于常规门诊治疗相关。

研究设计和参与者

在英国一家医院进行的随机、开放标签、盲法、终点试验。符合条件的参与者年龄在18岁或以上，患有先兆子痫或妊娠期高血压，出院后需要服用抗高血压药物。首次入组时间为2020年2月21日，最后一次随访时间为2021年11月2日。随访时间约为9个月。

干预措施

参与者按1:1的比例被随机分配进行自我监测，同时进行医生优化的抗高血压药物滴定或常规的产后护理。

主要结局

主要结局是产后9个月时的24小时平均舒张压，并根据出生后的基线血压进行调整。

结果

220名参与者被随机分配到干预组（n=112）或对照组（n=108）。参与者的平均（SD）年龄为32.6（5.0）岁，40%患有妊娠期高血压，60%患有先兆子痫。主要分析包括200名参与者（91%）。产后249（16）天测得的24小时平均（SD）舒张压，干预组（71.2[5.6]mm Hg）比对照组（76.6[5.7]mm Hg）低5.8 mm Hg。组间差异为-5.80 mm Hg（95%CI，-7.40至-4.20；P<.001）。同样，干预组的24小时平均（SD）收缩压（114.0[7.7]mm Hg）比对照组（120.3[9.1]mm Hg）低6.5 mm Hg。组间差异为-6.51 mm Hg（95%CI，-8.80至-4.22；P<.001）。

结论和相关性

在这项单中心试验中，自我监测和医生指导的抗高血压药物滴定与产后前9个月的血压低于英国通常的产后门诊护理相关。

英文原文如下：

Key Points

Question  Does use of remote self-monitoring and physician-guided titration of antihypertensive medications using a Bluetooth-enabled app provide better long-term blood pressure control than usual outpatient care during the first 9 months postpartum?

Findings  In this randomized clinical trial involving 220 participants, physician-guided self-management of outpatient postnatal blood pressure, following hypertensive pregnancy, was associated with a 6/5-mm Hg lower ambulatory blood pressure at 9 months postpartum.

Meaning  A physician-guided remote telemonitoring program was used to guide self-management of blood pressure and was associated with improved blood pressure control during the postnatal period after a hypertensive pregnancy compared with usual antihypertensive management.

Abstract

Importance  Pregnancy hypertension results in adverse cardiac remodeling and higher incidence of hypertension and cardiovascular diseases in later life.

Objective  To evaluate whether an intervention designed to achieve better blood pressure control in the postnatal period is associated with lower blood pressure than usual outpatient care during the first 9 months postpartum.

Design, Setting, and Participants  Randomized, open-label, blinded, end point trial set in a single hospital in the UK. Eligible participants were aged 18 years or older, following pregnancy complicated by preeclampsia or gestational hypertension, requiring antihypertensive medication postnatally when discharged. The first enrollment occurred on February 21, 2020, and the last follow-up, November 2, 2021. The follow-up period was approximately 9 months.

Interventions  Participants were randomly assigned 1:1 to self-monitoring along with physician-optimized antihypertensive titration or usual postnatal care.

Main Outcomes and Measures  The primary outcome was 24-hour mean diastolic blood pressure at 9 months postpartum, adjusted for baseline postnatal blood pressure.

Results  Two hundred twenty participants were randomly assigned to either the intervention group (n = 112) or the control group (n = 108). The mean (SD) age of participants was 32.6 (5.0) years, 40% had gestational hypertension, and 60% had preeclampsia. Two hundred participants (91%) were included in the primary analysis. The 24-hour mean (SD) diastolic blood pressure, measured at 249 (16) days postpartum, was 5.8 mm Hg lower in the intervention group (71.2 [5.6] mm Hg) than in the control group (76.6 [5.7] mm Hg). The between-group difference was −5.80 mm Hg (95% CI, −7.40 to −4.20; P < .001). Similarly, the 24-hour mean (SD) systolic blood pressure was 6.5 mm Hg lower in the intervention group (114.0 [7.7] mm Hg) than in the control group (120.3 [9.1] mm Hg). The between-group difference was −6.51 mm Hg (95% CI, −8.80 to −4.22; P < .001).

Conclusions and Relevance  In this single-center trial, self-monitoring and physician-guided titration of antihypertensive medications was associated with lower blood pressure during the first 9 months postpartum than usual postnatal outpatient care in the UK.

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