Early postpartum blood pressure self-monitoring with physician-guided medication adjustment was linked to sustained reductions in blood pressure among women with hypertensive pregnancies.
A randomized clinical trial published in JAMA in November 2023 demonstrated that structured self-monitoring of blood pressure with physician-guided medication titration in the early postpartum period led to significantly lower blood pressure through nine months after delivery among women with hypertensive pregnancies. Although the trial’s primary endpoints focused on blood pressure, the findings have taken on renewed relevance following downstream analyses linking postpartum blood pressure control to cardiovascular and neurologic outcomes.1
The study was led by Paul Leeson, PhD, and Jamie Kitt, DPhil, both of the University of Oxford, with Winok Lapidaire, PhD, senior postdoctoral research associate in the Department of Medicine at Oxford, as a co-author. Lapidaire is also the lead author of a subsequent study, published in January 2026, examining brain volumes after hypertensive pregnancy and postpartum blood pressure management, which will be the focus of a future video interview on Contemporary OB/GYN.2
“This research article that I wrote was part of a bigger study,” Lapidaire said. “The primary outcome of the study was actually looking into blood pressure. And the main aim of the study was to find out if the early postpartum window would be a good opportunity to introduce self-management to reduce the short-term blood pressure, but also see what impact that could have on the longer term.”
The randomized, open-label trial enrolled 220 women with pregnancies complicated by preeclampsia or gestational hypertension who required antihypertensive medication at hospital discharge. Participants were assigned to either usual postnatal care in the UK National Health Service or an intervention that included home self-monitoring using a Bluetooth-enabled blood pressure device linked to an app.1
“Women were randomized into their usual care in the NHS in England, or they were given a Bluetooth monitor at home with an app,” Lapidaire explained. “That would ask them to submit readings during the first few weeks after their delivery.”
In the intervention group, clinicians reviewed submitted readings and adjusted medications when values fell outside predefined thresholds.
“If a reading was outside of a certain set practice, then the doctor would maybe change their… medication, so they just have a much tighter blood pressure control with the doctor based on their self-management through blood pressure readings,” she said.
At a mean of 9 months postpartum, the intervention group had significantly lower 24-hour diastolic blood pressure—5.8 mm Hg lower than controls—as well as a 6.5 mm Hg reduction in systolic blood pressure. According to Lapidaire, the effects extended beyond blood pressure alone.
“We’re also seeing that their heart is remodeled quite differently from the usual care group,” she said. “There was also an effect seen on their brain volumes, and actually, the blood pressure effect seems to last longer as well.”
“They were only measuring self-monitoring for a couple of weeks at the most,” Lapidaire said. “Most women were off blood pressure management medications after that period, or even before then, but the effects were seen months after the intervention stopped.”
Lapidaire emphasized that the early postpartum period remains a gap in care, and the demonstrated benefits of care in this window.
“Women are kind of in between the obstetric care… but they’re also not yet in the cardiovascular care,” she said. “Many people think that as soon as the baby is delivered or the hypertension is gone, great, you’re all done. But actually, what we see is it’s not the case, and many women do need continued support, and their blood pressure does creep up slowly but surely after the delivery. So it’s very important to keep that, keep checking that, and keep on top of it, and change the medication when you need to.”
References:
Get the latest clinical updates, case studies, and expert commentary in obstetric and gynecologic care. Sign up now to stay informed.
