How do home and clinic blood pressure readings compare in pregnancy? A systematic review and individual patient data meta-analysis

Katherine L Tucker, Clare Bankhead, James Hodgkinson, Nia Roberts, Richard Stevens, Carl Heneghan, Évelyne Rey, Chern Lo, Manju Chandiramani, Rennae S Taylor, Robyn A North, Asma Khalil, Kathryn Marko, Jason Waugh, Mark Brown, Carole Crawford, Kathryn S. Taylor, Lucy Mackillop, Richard J McManus

Research output: Contribution to journalArticlepeer-review

20 Citations (Scopus)
157 Downloads (Pure)

Abstract

Hypertensive disorders during pregnancy result in substantial maternal morbidity and are a leading cause of maternal deaths worldwide. Self-monitoring of blood pressure might improve the detection and management of hypertensive disorders of pregnancy but few data are available, including regarding appropriate thresholds. This systematic review and individual patient data analysis aimed to assess the current evidence regarding differences between clinic and self-monitored blood pressure through pregnancy.MEDLINE and ten other electronic databases were searched for articles published up to and including July 2016 using a strategy designed to capture all the literature concerning self-monitoring of blood pressure during pregnancy. Investigators of included studies were contacted requesting individual patient data: self-monitored and clinic blood pressure and demographic data.Twenty one studies that utilised self-monitoring of blood pressure during pregnancy were identified. Individual patient data from self-monitored and clinic readings were available from seven plus one unpublished paper (eight studies, n=758) and two further studies published summary data. Analysis revealed a mean self-monitoring-clinic difference of ≤1.2mmHg systolic BP throughout pregnancy, though there was significant heterogeneity (difference in means I2>80% throughout pregnancy). Although the overall population difference was small, levels of ‘white coat hypertension’ were high, particularly towards the end of pregnancy.The available literature includes no evidence of a systematic difference between self and clinic readings, suggesting that appropriate treatment and diagnostic thresholds for self-monitoring during pregnancy would be equivalent to standard clinic thresholds. 
Original languageEnglish
Pages (from-to)686-694
Number of pages9
JournalHypertension
Volume72
Issue number3
Early online date6 Aug 2018
DOIs
Publication statusPublished - Sept 2018

Keywords

  • Self-monitoring
  • Pregnancy
  • Pre-eclampsia
  • hypertension
  • threshold
  • home-monitoring

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