Postpartum blood pressure trends and time in target range during remote blood pressure monitoring

Introduction Postpartum remote blood pressure monitoring (RBPM) programs have emerged as an important adjunct to the management of hypertensive disorders of pregnancy (HDP). These programs have demonstrated robust patient participation and satisfaction with reduced readmissions and severe maternal morbidity. Despite this, data describing blood pressure (BP) trends throughout program participation and across different antihypertensive regimens remain limited. We sought to evaluate BP trends and time in target range (TTR) during our 6‐week RBPM program. Methods This is a retrospective cohort study of postpartum individuals participating in an RBPM program from November 2023 through December 2024. This program utilizes a standardized nurse (RN)‐driven protocol for antihypertensive medication initiation and titration to achieve a goal BP of <140/90 mmHg. Target range was defined as SBP (systolic BP) 100–139 mmHg and DBP (diastolic BP) 60–89 mmHg. The primary outcomes were BP trend and TTR throughout program participation stratified by antihypertensive medication at discharge. Results The cohort included 465 individuals. Mean BPs were <140/90 mmHg for all groups for each program week. Most participants were within the target range throughout with TTR between 80.3% and 90.4%. Of participants, 175 (81.4%) were prescribed nifedipine monotherapy and 40 (18.6%) labetalol monotherapy. Mean BP trends were within goal for both groups; however, those discharged with nifedipine spent more TTR (nifedipine 87.5% vs. labetalol 80.3%, p = 0.03). There were no significant differences in rates of severe hypertension or hypotension; however, those on nifedipine experienced fewer elevated BPs and fewer patients who were discharged on nifedipine required antihypertensives at 6 weeks postpartum (nifedipine 35.7% vs. labetalol 73.5%, p < 0.001; adjusted odds ratio [OR], 0.27; 95% confidence interval [CI], 0.11–0.61). Conclusion Postpartum RBPM is an important tool for postpartum care. Utilization of a standardized RN‐driven protocol for antihypertensive medication initiation and titration can result in optimal BP management irrespective of medication regimen at discharge. These data suggest that nifedipine may be associated with more rapid and sustained achievement of target BPs throughout 6 weeks postpartum compared to labetalol.