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Significant racial disparities are observed in outcomes of women with pregnancy related hypertension (HTN). We evaluated whether text-based remote blood pressure (BP) monitoring could improve this disparity.
This was a planned secondary analysis of a randomized clinical trial that compared the effectiveness of text-based BP monitoring to usual care in-person BP visits for women with pregnancy related HTN in the early postpartum (PP) period. Women were randomized to either two weeks of text-based monitoring using an automated platform and home BP cuff (text) or usual care BP check at their prenatal office 4–6 days following discharge (usual care). Ascertainment of BP, defined as either office visit attendance or at least one BP texted, was compared among black and non-black women. Need for an oral antihypertensive and HTN readmission was compared between groups. Chi square was used to compare categorical variables. Poisson regression with a robust variance assumption was used to test for an interaction between BP ascertainment and race by trial arm to evaluate the impact of text on the disparity between black and non-black BP ascertainment.
206 women participated in the trial (103 per arm). Seventy-three (71%) women in usual care and 68 (66%) in text were black. Non-black women were significantly more likely than black women to present for a BP visit in usual care (70% vs 33%, p<0.001). Text-based monitoring significantly improved BP ascertainment for both black and non- black women compared to usual care (93% vs 33%, p<0.001 and 91% vs 70%, p =0.03 respectively). Remote monitoring was able to eliminate the racial disparity observed in BP ascertainment (p=0.002), with over 90% BP ascertainment in both race groups (p=0.85)(Figure). There were no HTN readmissions in the text arm, whereas 4 readmissions were observed in usual care (3 of the 4 in black women). There was no difference in the percent of black women started on BP medication amongst those who texted or attended their office visit (19% vs 21%, p=0.73).
Text-based monitoring eliminated the observed racial disparity in PP HTN care. Text as the standard would have likely led to medication initiation in an additional 20% or more women who missed an office visit. Given most strokes and maternal morbidity from pregnancy related HTN occur within 10 days of delivery, text message remote monitoring is an innovative way to equally engage all women in the PP period and reduce PP morbidity and mortality.