(985) Tight versus standard postpartum control following hypertensive disorders of pregnancy: a randomized controlled feasibility trial

Objective: To assess the feasibility of performing a randomized controlled trial (RCT) investigating tight versus standard postpartum blood pressure (BP) control following hypertensive disorder of pregnancy (HDP) through a postpartum remote monitoring program.

Study Design: We performed a single-blinded feasibility RCT from 11/2023-4/2024. Tight BP control was defined as medication initiation consistent with American Heart Association guidelines: inpatient BP (mmHg) ≥140/90 and/or outpatient ≥135/85 for two values at least 4 hours apart. Standard BP control was defined as medication initiation for BP ≥150/100 at least 4 hours apart. Eligible individuals were ≥18 years of age, diagnosed with HDP, and enrolled in our institution’s remote BP management program. Individuals were excluded if they were diagnosed with chronic hypertension, pre-gestational diabetes, renal or cardiac disease, a fetal anomaly, or currently used anti-hypertensives. We compared demographics, inpatient medication initiation, and outpatient medication initiation among groups.

Results: We enrolled 60 individuals over a 5-month time course out of 143 who were approached (43%); 29 were randomized to tight control and 31 to standard control. Average age, body mass index, race/ethnicity, health insurance status, and household incomes were similar among groups (Table). Those in the standard control arm were more likely to be diagnosed with preeclampsia, including with severe features (p=0.04). Anti-hypertensive medications were initiated at similar rates among groups both inpatient (31% tight vs 25.8% standard, p=0.65) and outpatient (20.7% tight vs 22.6% standard, p=0.86).

Conclusion: While a single center trial of tight versus standard postpartum BP control is feasible, there were similar rates of oral anti-hypertensive initiation among groups. This may be due to a differential representation of HDP severity among groups with a trend toward higher enrollment BP in patients randomized to standard control.