{"id":138203,"date":"2023-11-15T14:09:33","date_gmt":"2023-11-15T19:09:33","guid":{"rendered":"https:\/\/cardiologynownews.org\/?p=138203"},"modified":"2023-11-15T14:09:33","modified_gmt":"2023-11-15T19:09:33","slug":"self-monitoring-and-physician-optimized-antihypertensive-titration-post-partum-decreases-bp-during-the-first-9-months","status":"publish","type":"post","link":"https:\/\/cardiologynownews.org\/?p=138203","title":{"rendered":"Self-monitoring and physician-optimized antihypertensive titration post-partum decreases BP during the first 9 months"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">Key Points:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Up to 1 in 10 women experience a hypertensive disorder of pregnancy, which is associated with long-term cardiovascular disease. However there are no established interventions to reduce risk post-partum.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The POP-HT study examined the impact of a targeted physician-optimized postnatal BP control regimen on long-term BP control and cardiac remodeling.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Physician-Optimized post-partum BP control resulted in a significant reduction in both systolic and diastolic BP at 9 months, in addition to BP-related postnatal admissions and evidence of adverse cardiac remodeling on both cardiac MRI and echocardiogram.<\/span><\/li>\n<\/ul>\n<p><!--more--><\/p>\n<p><span style=\"font-weight: 400;\">Hypertensive disorders of pregnancy (HDP) impact 1 in 10 women, and 1\/3 of women who develop HDP subsequently develop chronic hypertension within the next decade. Additionally, HDP is associated with increased long-term CVD. However, there have been no established post-partum interventions to reduce the risk of long-term CVD in women with HDP. In a breaking presentation at the 2023 AHA Scientific Sessions today,\u00a0 <\/span><a href=\"https:\/\/www.rcplondon.ac.uk\/about-rcp\/whos-who\/people\/dr-jamie-kitt\"><span style=\"font-weight: 400;\">Dr. Jamie Kitt (High Wycombe Hospital)<\/span><\/a><span style=\"font-weight: 400;\"> and his team presented their study: \u201cLong-Term Blood Pressure Control After Physician Optimized Postpartum Blood Pressure Self-Management, \u201c or the <\/span><a href=\"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2811976\"><span style=\"font-weight: 400;\">POP-HT trial<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The POP-HT study <\/span><a href=\"https:\/\/clinicaltrials.gov\/study\/NCT04273854\"><span style=\"font-weight: 400;\">(NCT04273854)<\/span><\/a><span style=\"font-weight: 400;\"> randomized 220 adult (&gt;18 years) women with either gestational hypertension or pre-eclampsia who required antihypertensive medication at the point of discharge. Relevant exclusion criteria were significant renal or hepatic impairment, life expectancy &lt; 6 months, or pre-existing hypertension. Participants were randomized to either standard NHS post-partum care or the intervention arm, which involved self-monitored BP readings sent via smartphone app to the monitoring physician, with resultant physician-initiated BP medication changes. Participants were followed for 6-9 months, and BP was monitored at baseline, week 1, and week 6. A 24 hour ambulatory BP measurement was taken at the final visit, and a cardiac MRI (CMR) and echocardiogram were also performed. The primary outcome was the 24-hour average diastolic BP at 9 months postpartum. Secondary outcomes included 24-hour average systolic BP at 9 months postpartum, clinic diastolic BP at 9 months postpartum, postnatal readmission, and post-partum CMR\/ECHO findings.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The median age was 33, with a mean BMI of 28 and mean BP at first antenatal visit of 117 mm Hg; 60% of the participants had preeclampsia, and the remainder had gestational hypertension. Two hundred participants (91%) were included in the primary analysis. The intervention arm had a significantly reduced 24-hour average diastolic BP at 9 months postpartum (71.2 vs 76.7 mm Hg; between-group difference -5.80mm Hg, 95% CI -7.40, -4.20 mm Hg; p&lt;0.001). There was also a significant reduction in 24-hour average systolic BP at 9 months postpartum (114.0 vs 120.3 mm Hg; between-group difference -6.51mm Hg, 95% CI -8.80, -4.22 mm Hg; p&lt;0.001). There was a significant reduction in BP-related postnatal readmissions (8 vs 29, ARR 20%, NNT 5). There was also a significant reduction in LV mass and a significant increase in both LV and RV systolic function on cardiac MRI in the intervention arm, in addition to a significant reduction in left atrial volume and average E\/E\u2019 ratio on echocardiogram (all p&lt;0.001).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">When discussing the clinical implications of the study at the Scientific Sessions, Dr. Kitt stated: \u201cIn 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\u2026This trial identifies a potential need for a paradigm shift in the way women affected by hypertensive pregnancy are managed postnatally\u2026POP-HT demonstrates a &gt;5 mm Hg diastolic and almost 7 mm Hf systolic BP improvement\u2026.if maintained long-term, this could result in a ~20% reduction in lifetime CV risk.\u201d<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Key Points: Up to 1 in 10 women experience a hypertensive disorder of pregnancy, which is associated with long-term cardiovascular disease. However there are no established interventions to reduce risk post-partum. The POP-HT study examined the impact of a targeted physician-optimized postnatal BP control regimen on long-term BP control and cardiac remodeling. Physician-Optimized post-partum BP [&hellip;]<\/p>\n","protected":false},"author":40603,"featured_media":138204,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[883,8],"tags":[885,45,47,185],"ppma_author":[1029],"class_list":{"0":"post-138203","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-aha-2023","8":"category-news","9":"tag-aha-2023","10":"tag-conference","11":"tag-featured","12":"tag-news","13":"author-leah-kosyakovsky"},"authors":[{"term_id":1029,"user_id":40603,"is_guest":0,"slug":"leah-kosyakovsky","display_name":"Leah Kosyakovsky","avatar_url":"https:\/\/secure.gravatar.com\/avatar\/864bde69f6f1f80e91e4a97f0a0ba8daa64c2bb702be09ed787444c7dfa045bb?s=96&r=g","0":null,"1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":""}],"_links":{"self":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138203","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/users\/40603"}],"replies":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=138203"}],"version-history":[{"count":1,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138203\/revisions"}],"predecessor-version":[{"id":138205,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138203\/revisions\/138205"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/media\/138204"}],"wp:attachment":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=138203"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=138203"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=138203"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fppma_author&post=138203"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}