Remote blood pressure monitoring was non-inferior to clinic checks in high-risk pregnancy

Design

Multicentre, unblinded, non-inferiority randomised controlled trial

Population

270 pregnant women at high risk of pre-eclampsia at three Australian hospitals

Primary outcome

Perinatal composite: loss, >48 h high-level neonatal care or SGA

Effect

HR 1.0 (95% CI 0.57-1.76); any-cause admission HR 0.54 (0.30-0.97)

In a multicentre, unblinded non-inferiority trial at three Sydney hospitals (published April 2026), 270 pregnant women at high risk of pre-eclampsia were randomised either to usual in-person specialist hypertension clinic visits or to self-measured blood pressure with an automated cuff, readings sent by smartphone app for specialist review. Both groups had routine antenatal care.

The perinatal composite of perinatal loss, more than 48 hours of high-level neonatal care or a small-for-gestational-age baby did not differ (HR 1.0, 95% CI 0.57-1.76). Remote monitoring reduced total antenatal attendances (median 14 vs 16) and planned outpatient visits (10 vs 13) without more unscheduled presentations. Women monitored remotely were less likely to be admitted for any cause (HR 0.54, 0.30-0.97) or for hypertension (HR 0.41, 0.19-0.88), and filled more antihypertensive prescriptions.

For services with crowded antenatal clinics, this supports replacing some surveillance visits with validated home readings reviewed by the specialist team. It needs a validated device, clear action thresholds and someone responsible for reviewing the data; without those, home readings are only numbers on a phone.

• Consider remote blood pressure monitoring in place of some specialist clinic visits for women at high pre-eclampsia risk.
• Use a validated automated device and teach correct cuff size and technique.
• Set written thresholds that trigger a call or same-day review.
• Name the clinician who reviews uploaded readings and how often.
• Keep routine antenatal visits; the trial replaced extra surveillance, not standard care.

Why it matters

It suggests extra clinic surveillance can move home without a measurable cost to babies, freeing clinic time.

Don't overread it

With 270 women, the confidence interval is wide enough that a modest difference in rare outcomes cannot be excluded.

The statistics, in plain English

An HR of 1.0 with a CI of 0.57 to 1.76 means the data fit anything from a 43% reduction to a 76% increase in the composite, so 'no difference' here means 'no detectable difference in a trial of this size'. The fall in admissions is significant but a secondary outcome.

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