Home blood-pressure monitoring can replace some high-risk clinic visits

Design

Unblinded, multicentre, noninferiority randomised controlled trial (3 hospitals, Australia)

Population

270 pregnant women at high risk of pre-eclampsia referred for extra surveillance

Primary outcome

Perinatal composite: perinatal loss, prolonged high-level neonatal care, or small-for-gestational-age

Effect

No difference, hazard ratio 1.0 (95% CI 0.57 to 1.76); fewer admissions, hazard ratio 0.54 (0.30 to 0.97)

Women at high risk of pre-eclampsia are referred for extra blood-pressure surveillance, which means frequent clinic attendances. This unblinded, multicentre, noninferiority randomised trial across three Australian hospitals tested whether home monitoring with specialist review could substitute for some of those visits.

Among 270 women, the perinatal composite outcome (perinatal loss, prolonged high-level neonatal care, or a small-for-gestational-age baby) did not differ between arms, hazard ratio 1.0 (95% CI 0.57 to 1.76). The home-monitoring group had fewer total antenatal attendances (median 14 vs 16) and fewer planned appointments (10 vs 13), without more unscheduled presentations. They were also less likely to be admitted for any cause (hazard ratio 0.54, 95% CI 0.30 to 0.97) and for hypertension specifically (0.41, 0.19 to 0.88), and filled more antihypertensive prescriptions.

For a stretched antenatal service this is a workable way to cut clinic load without a safety signal, provided there is a validated monitor and a dependable specialist review pathway. In Indian practice, where hypertension clinics are often oversubscribed, the model is attractive but depends on reliable device access and follow-up.

• Offer home blood-pressure monitoring with specialist review as an option for women needing extra pre-eclampsia surveillance.
• Expect fewer scheduled clinic visits (median 10 vs 13) without more unscheduled presentations.
• Note the fewer all-cause and hypertension admissions in the remote arm as a supportive secondary finding.
• Put a validated automated monitor and a reliable review pathway in place before substituting remote for clinic checks.
• Keep standard antenatal care alongside home monitoring, not in place of it.

Why it matters

It moves high-risk blood-pressure surveillance out of the clinic without a safety penalty, which matters most where hypertension services are overstretched.

Don't overread it

The primary endpoint showed no difference in a noninferiority design, and the drop in admissions was a secondary outcome in an unblinded trial, so treat it as supportive rather than established.

The statistics, in plain English

The primary hazard ratio of 1.0 with a wide interval (0.57 to 1.76) is consistent with no harm but, in 270 women, cannot exclude a moderate difference; the admission interval (0.30 to 0.97) just excludes 1.0.

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