When a new mother with high blood pressure is sent home with her newborn, she leaves the hospital with instructions to return—or visit her doctor—for a blood pressure check within the first 72 hours after discharge from the hospital. And she must repeat that visit seven to 10 days later.

Some pregnant women have high blood pressure, or hypertension, at the time of conception; others may develop it during pregnancy as a symptom of preeclampsia or eclampsia. In any case, it’s vital for these women to continue to monitor blood pressure after labor and delivery. Left unchecked, high blood pressure can cause headache, fluid retention and nausea, as well as organ damage, stroke and worse. Worldwide, hypertension is the second leading cause of maternal mortality, according to the World Health Organization.

But those follow-up visits can cause logistical problems for a woman at home with a newborn, especially if she has other children to care for as well. “It’s unrealistic to expect moms with newborns to pack up the baby and drive back to their doctor so soon after birth. Or ask them to use public transportation, or arrange for childcare for their just-born child—especially if they’re breastfeeding,” says Roxane Rampersad, MD, maternal-fetal medicine specialist at the Women & Infants Center, a collaboration by Barnes-Jewish Hospital, Washington University Physicians and St. Louis Children’s Hospital. As a result, she says, “women who needed special care weren’t coming in.” In fact, at Barnes-Jewish Hospital just 20% of new moms with high blood pressure were complying with postpartum instructions.

We wanted a program that would work for all participants.

To help these women take better care of their health, Rampersad says, she and colleagues wanted to create a system that would make it easier for them to get blood-pressure checks as recommended. The goal was to find a way to monitor them so adjustments could be made to their medications as needed, and they could be admitted to the hospital if their hypertension was trending in the wrong direction.

Digital health care offers answers

The solution to the problem turned out to be text messaging. The University of Pennsylvania School of Medicine showed in a study that a text message-based system used to facilitate easy communication could work for moms with high blood pressure. The study was done in 2016, years before the SARS-CoV-2 pandemic pushed the need for virtual patient-doctor connections to the forefront.

Rampersad and the team decided to pursue remote monitoring, teaching patients to take their own blood-pressure readings at home and report the results to a medical team. This system would eliminate the difficulty of in-office visits and, the team hoped, ensure more women were getting the postpartum care they needed to stay healthy.

Plans to launch the remote blood-pressure program for moms in St. Louis were in progress before the pandemic began in 2020, says Megan Chinen Oakes, MD, maternal-fetal medicine specialist and second-year fellow at Washington University School of Medicine, but the team accelerated their timeline once the pandemic began. They knew that worries about COVID-19 and on-campus restrictions applying to visitors, including newborns and children, would further discourage women from coming in for blood-pressure checks.

Text-based communications

Launched in April 2020, the remote blood-pressure monitoring program has now worked with more than 1,000 moms and has entered its second year. The program is designed for women who had high blood pressure prior to conception and those who developed it during pregnancy. After labor and delivery, each participant in the program is sent home with a blood pressure monitor. Twice a day for 14 days, these moms receive a text message instructing them to take their blood pressure and submit the results via text.

“It’s really simple to use. It’s just texting,” says Oakes, and it doesn’t require an expensive smart phone; any cellphone will do. Unlike video conference calls and other, less user-friendly platforms, sending texts via cellphone is familiar to most and easily learned for others.

The texts between patient and health-care provider are managed by a web-based, HIPAA-compliant platform that ensures a patient’s right to privacy. (HIPAA is the government regulation that protects the right to privacy in health care.) Doctors and nurses review the texts participants send around the clock. If a health-care provider notices that someone’s blood pressure is too low, too high, or moving in the wrong direction, the provider can give instructions for adjusting medication and can alert the patient of the need to return to the hospital for care if necessary.

Oakes says that in the first few months of the program, patient compliance jumped from 20% to 90%. “We won’t ever achieve zero hospital readmissions due to high blood pressure. That’s the nature of hypertension. But we are helping to keep women safe and at home with their babies and their families.”

Oakes adds that women in the program seem to have become more engaged in their own health and welfare. “We offer education about high blood pressure and its risks and, as a result, we are finding that our participants are more invested, more involved and more proactive in their own care. They have learned what to look for, they know what’s normal for them and what isn’t.”

Setting up for future, equitable success

So far, the remote blood-pressure monitoring program has seen success across socioeconomic backgrounds, including women who receive health care through primary care physicians, hospitals and health clinics. Rates of compliance are about the same for those with private and public health insurance, too. “We wanted a program that would work for all participants,” Rampersad says. Part of the plan for equity includes offering a cellphone and text plan, and blood pressure monitor to participants at no cost.

The current program is supported by The Foundation for Barnes-Jewish Hospital and receives funding from the Women & Infants Center. A generous gift from the Lowenhaupt Family was earmarked for the purchase of varying sizes of pressure cuffs, thus ensuring women of all sizes can be part of the program.

The program’s medical team is monitoring results through multiple research studies, with an eye toward publishing findings in 2021. The team also is working to educate insurance companies about the success of the program in the hope that the costs the hospital incurs eventually will be covered.

The pandemic made innovations in patient care, like this program, even more valuable. “Some of these kinds of initiatives existed before COVID-19,” says Oakes, “but they became more vital in this past year. And in many cases, we’ve discovered they work really well. Now we need to make them part of our standard of care.”