Hampton - Eligibility for Home Blood Pressure Monitoring

Background:

• Home Blood Pressure Monitoring (HBPM) allows a woman to self-monitor her blood pressure at home. Home readings may provide a more frequent or accurate picture of a woman’s BP than intermittent DAU or clinic readings. There is growing evidence for its role in pregnancy.
  
• Our experience so far shows a reduction in unnecessary DAU visits without incurring any adverse outcomes. Women report a positive experience.
  
• HBPM is not intended to replace necessary clinical reviews and monitoring of proteinuria, maternal blood tests or fetal wellbeing. 
  
• We have developed a dynamic web-based application to make it easy for patients to record their results and for healthcare professionals to review their results. Women are able to enter blood pressures as long as they have access to a web browser. The application has been specifically designed to be as inclusive as possible.
  

HBPM requires excellent compliance from patients and vigilance from staff to make sure it is being used safely.

K2 Hampton can be offered to:

2. Women determined as high-risk by NICE guidelines (or by the FMF first trimester screening)

3. Women with chronic hypertension, gestational hypertension, pre-eclampsia

Women determined as high-risk by NICE guidelines:

Eligibility for women with Hypertension in pregnancy

Staff working in DAU can offer HBPM to any woman who they think would benefit from it. The majority of these women will fulfil standard criteria for DAU referral and monitoring (gestational hypertension or borderline BP after 20 weeks gestation). Women with chronic hypertension who are booked for antenatal care with the maternal medicine team will have HBPM initiated through the hypertension clinic. Women who are seen in antenatal clinic with hypertension who do not fulfil DAU referral criteria (such as gestation less than 20 weeks) should be referred to your specialist team for the initiation of HBPM.

• Each team (DAU/Maternal Medicine) will be responsible for overseeing their own patients and ensuring appropriate follow-up plans are in place.
  
• Maternal medicine patients will be assessed by a member of the maternal medicine team regarding their suitability for HBPM whilst DAU patients should fit the criteria listed below.
  

Inclusion criteria:

1. Any woman with mild-moderate hypertension in pregnancy 
   
2. Gestational Hypertension (GH) 
   
3. Chronic Hypertension
   
4. White Coat Hypertension / ‘borderline BP profiles’. 
   
5. No significant proteinuria (see below)
   
6. Women must have a good understanding of English (written and spoken) so that they can follow the instructions and give informed consent.
   
7. No clinical indication for inpatient monitoring.
   

Exclusion Criteria:

1. Unable to give consent or understand the instructions.
   
2. Declines HBPM 
   
3. Evidence of non-compliance with attendance or monitoring.
   
4. Arm circumference greater than 42cm 
   
5. Delivery planned within 7 days
   
6. Severe, uncontrolled hypertension that requires the woman to be admitted for stabilisation (HBPM can be started if she improves clinically and is appropriate for outpatient care). 
   
7. Any woman where there is concern over fetal growth/wellbeing.
   
8. Woman with ≥ 2+ protein on dipstick or a positive PCR result (≥30).
   

Pre-Eclampsia Tests:

There are currently two tests available on the market to test for pre-eclampsia. One which measures soluble fms-like kinase 1 (sFlt-1) and placenta; growth factor (PlGF) ratio to predict pre-eclampsia and one that measures just placental growth factor (PlGF). Either are valid test and we do no recommend one over the other. Below are the pathways that help determine whether women are eligible for HBPM or not.

sFlt/PlGF Ratio test