Feasibility of Postpartum Blood Pressure Monitoring for Hypertensive Disorders in a Low-Resource Setting

BACKGROUND: Hypertensive disorders of pregnancy (HDP) pose significant risks to maternal health globally, especially in Nigeria, which has the highest maternal mortality rate. Home blood pressure (BP) monitoring is a promising approach for managing HDP. OBJECTIVES: This study assessed the feasibility of a postpartum home BP-monitoring program for women with HDP in low-resource settings like Nigeria, focusing on recruitment, retention, and fidelity to monitoring protocols. HDP diagnoses associated with persistent hypertension were also assessed. METHODS: Participants with HDP were enrolled into a prospective cohort. They were educated on BP monitoring and transmitted daily BP readings for 2 weeks. A control group of healthy postpartum women was also enrolled. The 12-week study involved assessments at prespecified intervals. RESULTS: The study met its target of 90 participants (mean age: 30 years) and had high fidelity (96%) to daily BP recordings and retention (94%) at 12 weeks. The mean systolic BP decreased from 137 mm Hg to 125 mm Hg, and the mean diastolic BP decreased from 89 mm Hg to 84 mm Hg. During the initial 2-week period, 81.1% of normotensive participants experienced elevated BP, with 86.5% showing elevated BP over 12 weeks. In addition, 22% reported adverse cardiovascular events. CONCLUSIONS: The study demonstrates the feasibility of a postpartum BP-monitoring program in a low-resource setting like Nigeria, with high recruitment, fidelity, and retention. Continued monitoring beyond the immediate postpartum period is essential for improving outcomes. Further research is needed to evaluate the long-term effectiveness and scalability of such programs.