(850) Can remote blood pressure monitoring reduce racial disparities in outcomes among postpartum patients with hypertension?

Remote self-measured blood pressure (SMBP) monitoring programs have been shown to reduce racial inequity in postpartum blood pressure ascertainment. However, their effect on disparities in healthcare utilization and severe maternal morbidity (SMM) is less clear. We aimed to compare outcomes between participants in our remote SMBP program who self-identified as Black versus non-Hispanic White.

Study Design:

Postpartum individuals with hypertension (HTN) at our tertiary hospital are offered enrollment in our remote SMBP program. For this analysis, participants who did not self-identify as Black or non-Hispanic White were excluded. The primary outcome was a composite of HTN-related postpartum readmission or ED visit within 30 days of delivery. Secondary outcomes were individual components of the primary composite, HTN-related SMM, and anti-hypertension medication initiation or titration. A log-link binomial generalized linear model was used to estimate relative risks (aRR) adjusting for potential confounders.

Results:

Among 2003 participants in the SMBP program from 2022 - 2024, 1363 met inclusion criteria. Of these, 988 (49.3%) self-identified as non-Hispanic White and 375 (18.7%) as Black. Compared to non-Hispanic White participants, Black participants were younger, and more likely to have public insurance and gestational HTN (Table 1). After adjusting for these factors, there was no significant difference in the composite of HTN-related postpartum readmission or ED visit between Black and non-Hispanic White participants (19.2% vs 16.7%; aRR 1.29, 95% CI 0.98, 1.69). Risk of HTN-related readmission alone was significantly higher among Black participants (12.2% vs 9.9%; aRR 1.48, 95% CI 1.03, 2.11). There was no significant difference in HTN-related SMM (12.5% vs 11.7%; aRR 1.00, 95% CI 0.72, 1.42). There was also no difference in anti-hypertensive medication initiation or titration (Table 2).

Conclusion: Our remote SMBP program for postpartum patients with HTN eliminated racial disparities in overall HTN-related healthcare utilization and HTN-related SMM.