Self-monitoring of BP for high-risk pregnancy not so useful: JAMA study

Primary outcome data were available for 2346 of 2441 randomized study participants. Baseline characteristics were similar for both groups. Among the 15% of individuals who developed a hypertensive disorder of pregnancy, time from randomization to diagnosis was not statistically significantly different that is 104 days in the SMBP group vs 106 days in the usual care group, The BUMP 1 trial raises several issues.

BUMP 1 enrolled a heterogeneous group of individuals at-risk for preeclampsia, based on vascular risk factors. Although subgroup analysis by recommended use of aspirin, socioeconomic status, or gestational age at study entry showed no differences, subgroup analyses by clinical indication for trial entry would have additional utility to clinicians.

Moreover, in clinical practice, the question extends to beyond latency in diagnosis of hypertensive disorders of pregnancy and includes the effect of the diagnosis on maternal and neonatal morbidity, particularly among the highest-risk individuals. BUMP 1 was not powered to identify differences in these outcomes.

The BUMP 1 trial also identified an important challenge in the management of hypertension in that 26.9% of participants had a discrepancy between home and clinic BP readings despite using a validated monitor.

These discrepancies, attributable to white coat hypertension and masked hypertension, may have also contributed to the negative primary outcome.

In addition, in the context of the COVID-19 pandemic, during which telemedicine and self-monitoring might replace usual care for low-risk individuals, the clinical benefit of SMBP remains untested.