A randomized controlled trial comparing remote blood pressure monitoring with office-based blood pressure monitoring for women at high risk of preeclampsia.

Λεπτομέρειες βιβλιογραφικής εγγραφής
Τίτλος:	A randomized controlled trial comparing remote blood pressure monitoring with office-based blood pressure monitoring for women at high risk of preeclampsia.
Συγγραφείς:	Rajkumar T; School of Medicine, Western Sydney University, New South Wales, Australia; Department of Renal Medicine, South Western Sydney Local Health District, New South Wales, Australia. Electronic address: theepika.rajkumar@health.nsw.gov.au., Hennessy A; School of Medicine, Western Sydney University, New South Wales, Australia; School of Medicine, University of Sydney, Westmead, New South Wales, Australia., Shanmugalingam R; School of Medicine, Western Sydney University, New South Wales, Australia; Department of Renal Medicine, South Western Sydney Local Health District, New South Wales, Australia; University of New South Wales, New South Wales, Australia., You W; School of Nursing and Midwifery, Western Sydney University, New South Wales, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia., Canty A; Women's Health Initiative Translational Unit, Ingham Institute for Applied Medical Research, South Western Sydney Local Health District, New South Wales, Australia., Pickup W; Women's Health Initiative Translational Unit, Ingham Institute for Applied Medical Research, South Western Sydney Local Health District, New South Wales, Australia., Potter D; Department of Renal Medicine, South Western Sydney Local Health District, New South Wales, Australia., Butten K; Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Queensland, Australia., Varnfield M; Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Queensland, Australia., Makris A; School of Medicine, Western Sydney University, New South Wales, Australia; Department of Renal Medicine, South Western Sydney Local Health District, New South Wales, Australia; University of New South Wales, New South Wales, Australia; Women's Health Initiative Translational Unit, Ingham Institute for Applied Medical Research, South Western Sydney Local Health District, New South Wales, Australia.
Πηγή:	American journal of obstetrics and gynecology [Am J Obstet Gynecol] 2026 Oct; Vol. 235 (4), pp. 952-965. Date of Electronic Publication: 2026 Apr 21.
Τύπος έκδοσης:	Equivalence Trial; Journal Article; Multicenter Study; Randomized Controlled Trial
Γλώσσα:	English
Στοιχεία περιοδικού:	Publisher: Elsevier Country of Publication: United States NLM ID: 0370476 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-6868 (Electronic) Linking ISSN: 00029378 NLM ISO Abbreviation: Am J Obstet Gynecol Subsets: MEDLINE
Imprint Name(s):	Publication: <2005->: New York : Elsevier Original Publication: St. Louis.
Ιατρικοί όροι (MeSH):	Blood Pressure Determination/methods , Blood Pressure Monitoring, Ambulatory/methods , Pre-Eclampsia/diagnosis , Pre-Eclampsia/prevention & control, Prenatal Care/methods ; Adult ; Female ; Humans ; Pregnancy ; Australia ; Office Visits ; Remote Patient Monitoring
Περίληψη:	Background: Women at a high risk of developing preeclampsia are recommended to have additional blood pressure surveillance, but frequent outpatient attendances are demanding for patients and the healthcare system. It is unclear whether remote blood pressure monitoring can replace conventional office-based monitoring and improve healthcare utilization without increasing the signal for harm. Objective: To evaluate the effects of substituting clinic blood pressure monitoring with remote blood pressure monitoring on fetal and maternal outcomes, and healthcare utilization, in pregnant women at a high risk of developing preeclampsia. Study Design: Unblinded, noninferiority, multicenter randomized controlled trial, with recruitment between July 2022 and February 2024 from 3 metropolitan hospitals in Australia. Participants were pregnant women at a high risk of developing preeclampsia based on clinical risk factors or combined first-trimester screening tests, who are routinely referred to a specialist hypertension service for extra blood pressure surveillance, in addition to standard antenatal care. Women randomized to usual care attended these specialist hypertension clinics in-person, with frequency of appointments dictated by clinical need. Women randomized to remote blood pressure monitoring, in addition to receiving routine antenatal care, measured their own blood pressure using an automated blood pressure machine with data transmitted via a smartphone application for specialist review. The primary outcome was a perinatal composite of adverse events of at least one of perinatal loss, high-level neonatal care for more than 48 hours, or a small-for-gestational age baby (<10th centile for fetal weight). The primary outcome was assessed in the intention-to-treat population. The trial was prospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12620001049965p). Results: 270 women were included in the final analysis (intervention n=132, usual care n=138; mean age 34 years, 60.4% from a self-reported non-Caucasian ethnic group). There was no difference in the primary outcome (hazard ratio, 1.0; 95% confidence interval, 0.57-1.76; P=.99). There was also no difference in secondary fetal and maternal outcomes. The intervention group had less total antenatal attendances (median [interquartile range], 14 [10-17]) compared to usual care (16 [13-20]; P<.01) and less planned outpatient appointments (median [interquartile range], 10 [8-12] vs 13 [10-16]; P<.01), without an associated increase in unscheduled hospital presentations. Women undertaking remote blood pressure monitoring were less likely to be admitted to hospital for any cause (hazard ratio, 0.54; 95% confidence interval, 0.30-0.97; P=.04) and specifically for hypertension (hazard ratio, 0.41; 95% confidence interval, 0.19-0.88; P=.02). More antihypertensive prescriptions filled per patient in the intervention arm compared to usual care (median [interquartile range], 5 [3-9] vs 3 [2-5]; P<.01). Conclusion: Compared to usual care, remote blood pressure monitoring reduced antenatal outpatient appointments and the likelihood of inpatient admissions, without increasing adverse fetal and maternal outcomes. Women undertaking remote monitoring were also more likely to fill antihypertensive medication scripts. (Copyright © 2026 The Author(s). Published by Elsevier Inc. All rights reserved.)
Contributed Indexing:	Keywords: blood pressure; high-risk antenatal care; high-risk pregnancy; home blood pressure monitoring; hypertensive disorders of pregnancy; mobile application; preeclampsia; remote blood pressure monitoring; remote maternal monitoring; substitution of specialist visits; telemedicine in pregnancy
Entry Date(s):	Date Created: 20260423 Date Completed: 20260917 Latest Revision: 20260925
Update Code:	20260925
DOI:	10.1016/j.ajog.2026.04.025
PMID:	42025715
Βάση Δεδομένων:	MEDLINE

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ISSN:	1097-6868
DOI:	10.1016/j.ajog.2026.04.025