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. 2025 May;4(5):101739.
doi: 10.1016/j.jacadv.2025.101739.

Feasibility of Postpartum Blood Pressure Monitoring for Hypertensive Disorders in a Low-Resource Setting

Zainab Mahmoud  1 , Chukwuebuka F Okoye  2 , Adaego A Orji  2 , Friday O Ameh  3 , Cecilia Nartey  4 , Godwin Akaba  3 , Bissallah A Ekele  3 , Erica L Jamro  4 , Kathryn J Lindley  5 , Dike B Ojji  6 , Mark D Huffman  7
Affiliations

Feasibility of Postpartum Blood Pressure Monitoring for Hypertensive Disorders in a Low-Resource Setting

Zainab Mahmoud et al. JACC Adv. 2025 May.

Abstract

Background: Hypertensive disorders of pregnancy (HDP) pose significant risks to maternal health globally, especially in Nigeria, which has the highest maternal mortality rate. Home blood pressure (BP) monitoring is a promising approach for managing HDP.

Objectives: This study assessed the feasibility of a postpartum home BP-monitoring program for women with HDP in low-resource settings like Nigeria, focusing on recruitment, retention, and fidelity to monitoring protocols. HDP diagnoses associated with persistent hypertension were also assessed.

Methods: Participants with HDP were enrolled into a prospective cohort. They were educated on BP monitoring and transmitted daily BP readings for 2 weeks. A control group of healthy postpartum women was also enrolled. The 12-week study involved assessments at prespecified intervals.

Results: The study met its target of 90 participants (mean age: 30 years) and had high fidelity (96%) to daily BP recordings and retention (94%) at 12 weeks. The mean systolic BP decreased from 137 mm Hg to 125 mm Hg, and the mean diastolic BP decreased from 89 mm Hg to 84 mm Hg. During the initial 2-week period, 81.1% of normotensive participants experienced elevated BP, with 86.5% showing elevated BP over 12 weeks. In addition, 22% reported adverse cardiovascular events.

Conclusions: The study demonstrates the feasibility of a postpartum BP-monitoring program in a low-resource setting like Nigeria, with high recruitment, fidelity, and retention. Continued monitoring beyond the immediate postpartum period is essential for improving outcomes. Further research is needed to evaluate the long-term effectiveness and scalability of such programs.

Keywords: hypertension; hypertensive disorders of pregnancy; postpartum blood pressure monitoring.

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Conflict of interest statement

Funding support and author disclosures This study was supported by grant funding from the American College of Cardiology, Association of Black Cardiologists, and Merck Foundation. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. Dr Mahmoud is supported by the NIH/NHLBI grant K23HL173684. Dr Huffman has received travel support from the World Heart Federation and consulting fees from PwC Switzerland; has an appointment at The George Institute for Global Health, which has a patent and license and has received investment funding with the intent to commercialize fixed-dose combination therapy through its social enterprise business, George Medicines; and has pending patents for heart failure polypills. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

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Graphical abstract
Central Illustration
Central Illustration
Feasibility of Postpartum Blood Pressure Monitoring for Hypertensive Disorders in a Low-Resource Setting
Figure 1
Figure 1
Participant Blood Pressure Control Over Time by Diagnosis
See this image and copyright information in PMC

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