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Hypertension Control: A Public Health Priority

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Last week, Surgeon General Dr. Jerome M. Adams, issued a national Call to Action urging Americans to recognize and address hypertension control as a public health priority. The report summarizes the recent data on hypertensive disorders, identifies and promotes various strategies for improving outcomes, and provides recommendations for targeted areas of focus where resources are limited.

Hypertension and Maternal Health

One of the many devastating effects of hypertension that Dr. Adams addresses is the impact on mothers and babies both before and after pregnancy. As he notes in his report, hypertensive disorders with onset during pregnancies are among the leading causes of maternal and infant mortality and morbidity in the US, and can have far-reaching consequences for the long-term health of the mother and child. 

By The Numbers

● About nine in 100 delivery hospitalizations include a diagnosis of a hypertensive disorder.

● Hypertensive disorders with onset during pregnancy are responsible for 7.8% of all pregnancy-related deaths.

● Gestational hypertension is present in about 2%–3% of pregnancies.

● Preeclampsia is present in about 3% of pregnancies.

● A history of hypertensive disorders in pregnancy is associated with a risk of future coronary heart disease, heart failure, stroke, hypertension, diabetes, abnormal heart rhythms, end-stage kidney disease, and cardiomyopathy.

Self-Measured Blood Pressure Monitoring

Among his recommendations for controlling hypertension, Dr. Adams referenced the success of health care providers who have promoted shared management through self-measured blood pressure monitoring (SMBP), empowering patients through blood pressure (BP) management and goal setting.

This recommendation is not unusual — SMBP is well accepted in primary care for managing hypertension — but its use in pregnancy has not been routine.

This attitude has steadily begun to change, however, as recent research shows the efficacy of SMBP for identifying and controlling hypertensive complications in the prenatal and postpartum period, including studies out of Penn Medicine’s Heart Safe Motherhood Program and the University of Pittsburgh Medical Center, and initiatives such as Million Hearts 2022 have brought together industry experts to discuss the benefits of SMBP for the pregnant population and beyond.

This change has been further motivated by the pandemic. As providers have been forced to transition care outside of the clinic and patients are increasingly anxious about attending in-office appointments even for essential procedures, SMBP provides a means to adhere to ACOG’s new guidelines for increased BP monitoring during the prenatal and postpartum period from the comfort and safety of a patient’s home.

Moreover, of those mentioned by Dr. Adams in his report, the pregnant population is perhaps the most likely demographic to experience success with SMBP. Women of childbearing age are ideally suited for the use of supplemental care technologies like remote patient monitoring. Pregnancy is also a defined health event, unlike a chronic condition that may persist indefinitely. It involves another person — a mother is more likely to engage with a solution because the health of her baby is at stake in addition to her own. 

With women educated to take their own BP, remote monitoring can be started early in pregnancy and continued through the postpartum period. Adding in an educational layer — as Jollitot does with their ThriveBaby mobile app —  safely and conveniently fills the care gap that many women experience.

There is also an emphasize on the importance and attainability of continuous care. The usual schedule in pregnancy is to have an office visit every 4 weeks with more frequent visits as the due date nears. But empowering women to be part of their health care between or in place of these visits is possible and important. Women are capable of taking their own BP and learning to follow their BP trends — even recognizing when BP begins to rise. Adding in technology so that providers can monitor their patients in real time adds a dimension that is sure to transform healthcare.

The introduction of SMBP is not a solution in and of itself, however. As Dr. Adams and others have noted, social and economic risk factors are a primary culprit in poor outcomes, and without addressing systemic problems such as implicit bias, absence of family or community support, lack of education or coverage, and other factors, no technology can successfully resolve the troubling statistics around hypertensive disorder or any other health condition. 

However, as a layer of a holistic approach to care that enables patient empowerment and enhances provider, payer, care team, and community support for those suffering from hypertensive disorders and their effects, it is an essential tool and should be promoted as such.

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