Blood Pressure Monitoring in High Risk Pregnancy to Improve the Detection and Monitoring of Hypertension

NCT ID: NCT03334149

Last Updated: 2022-06-06

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

3042 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-11-22

Study Completion Date

2020-09-16

Brief Summary

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Raised blood pressure is a common problem in pregnancy. Raised blood pressure and pre-eclampsia affect about one in ten women and are a major cause of death and premature birth in the United Kingdom and worldwide.

Many women have expressed an interest in monitoring their own blood pressure in between antenatal visits but there has been very little research to guide this. The investigators would like to know if the diagnosis and subsequent care of women with raised blood pressure can be improved if women were able to monitor their own blood pressure safely at home. This work will test whether optimising the diagnosis, monitoring and management of raised BP during pregnancy through self-monitoring of BP is effective, acceptable and cost-effective compared to usual care.

The research team have being working with pregnant women, doctors and midwives to develop a simple and accurate method of self-monitoring of blood pressure in pregnancy.

This randomised controlled trial will:

1. Compare self-monitoring with usual care in women at higher risk of hypertension in pregnancy and assess if self-monitoring can identify raised blood pressure earlier.
2. Compare self-monitoring with usual care for women with high blood pressure in pregnancy to see if it leads to lower blood pressure.
3. Assess if self-monitoring is cost-effective.

Pregnant women who chose to take part in these studies will be randomised to either usual care or asked to monitor their own blood pressure during their pregnancy in addition to their usual antenatal care.

Detailed Description

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BUMP 1 will randomise 2262 women at higher risk of hypertension in pregnancy into usual care or self-monitoring.

BUMP 2 will randomise 512 women with hypertension in pregnancy (including chronic hypertension) into usual care or self-monitoring. Women in BUMP 1 will move into BUMP 2 if they develop hypertension.

Women will be recruited at approximately 15 hospitals in England over approximately 24 months.

Women will be recruited from 20 weeks (BUMP 1) or early pregnancy(BUMP 2) and followed up until 2 months after birth.

Conditions

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Pregnancy, High Risk Pre-Eclampsia Hypertension Hypertension, Pregnancy-Induced

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Note Women in BUMP 1 will transfer to BUMP 2 if they develop hypertension. Women in BUMP 2 can be randomised de novo or join from BUMP 1 maintaining their original randomisation. The enrolment number below therefore includes BUMP 1 (2262) plus BUMP 2 (512). Permission was granted by the ethics committee to continue recruitment passed the original sample size until the original planned end of recruitment date.
Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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Self-Monitoring of Blood Pressure

BUMP 1: using a validated home blood pressure monitor at least 3 times a week to record blood pressure BUMP 2: using a validated home blood pressure monitor daily to record blood pressure Women in the intervention groups will be encouraged to use a simple mobile tele monitoring system.

Group Type EXPERIMENTAL

Self-Monitoring of Blood Pressure

Intervention Type OTHER

BUMP 1: Women randomised to the self-monitoring arm will be asked to measure blood pressures at least three times a week. They will perform two readings with a one minute interval and will be asked to act on the second reading if it falls outside their normal range thresholds described in their instructions, and aided by the tele monitoring system.

BUMP 2: Women randomised to the self-monitoring arm will be asked to measure blood pressures daily. They will perform two readings with a one minute interval and will be asked to act on the second reading if it falls outside their normal range thresholds described in their instructions, aided by a tele monitoring system.

Usual Care

Women randomised to usual care will continue to have all their BP monitoring completed by the clinical team at their antenatal assessments.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Self-Monitoring of Blood Pressure

BUMP 1: Women randomised to the self-monitoring arm will be asked to measure blood pressures at least three times a week. They will perform two readings with a one minute interval and will be asked to act on the second reading if it falls outside their normal range thresholds described in their instructions, and aided by the tele monitoring system.

BUMP 2: Women randomised to the self-monitoring arm will be asked to measure blood pressures daily. They will perform two readings with a one minute interval and will be asked to act on the second reading if it falls outside their normal range thresholds described in their instructions, aided by a tele monitoring system.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Participant is willing and able to give informed consent for participation in the trial
* Pregnant woman, aged 18 years or above between 16+0 to 24+0 weeks
* Able and willing to comply with trial requirements
* Willing to allow her general practitioner and consultant, if appropriate, to be notified of participation in the trial
* At higher risk for hypertension in pregnancy / pre-eclampsia defined as one or more of the following risk factors:
* Age 40 years or older
* Nulliparity
* Pregnancy interval of more than 10 years
* Family history of pre-eclampsia
* Previous history of pre-eclampsia or gestational hypertension
* Body mass index 30 kg/m2 or above at booking
* Chronic kidney disease
* Twin pregnancy
* Diabetes (Type 1\&2)
* Autoimmune Disease (eg systemic lupus erythematosis or antiphospholipid disease)


• Women developing pregnancy hypertension previously randomised in BUMP 1 (regardless of gestation).

OR

* Women with chronic hypertension (defined as sustained systolic BP≥140 mmHg and/or diastolic BP≥90 mmHg, present at booking or before 20 weeks' gestation, or receiving treatment outside pregnancy and/or at time of referral).
* Recruited up to 37+0 weeks' gestation.

OR

* Women with hypertension after 20 weeks' gestation (defined as sustained systolic BP≥140 mmHg and/or diastolic BP≥90 mmHg).
* Recruited at 20+0 to 37+0 weeks' gestation.

AND

* Participant is willing and able to give informed consent for participation in the trial.
* Woman aged 18 years or above.
* Willing to allow her general practitioner and consultant, if appropriate, to be notified of participation in the trial.

Exclusion Criteria

* Chronic Hypertension

BUMP 2:


Anticipated inpatient admission considered likely to lead to imminent delivery (within the next 48 hours)
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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King's College London

OTHER

Sponsor Role collaborator

Oxford University Hospitals NHS Trust

OTHER

Sponsor Role collaborator

University of Southampton

OTHER

Sponsor Role collaborator

University of Birmingham

OTHER

Sponsor Role collaborator

Barts & The London NHS Trust

OTHER

Sponsor Role collaborator

City, University of London

OTHER

Sponsor Role collaborator

National Institute for Health Research, United Kingdom

OTHER_GOV

Sponsor Role collaborator

University of Oxford

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Richard J McManus, PhD MBBS

Role: PRINCIPAL_INVESTIGATOR

University of Oxford

Locations

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Buckinghamshire Healthcare NHS Trust

Aylesbury, , United Kingdom

Site Status

Birmingham Women's and Children's Hospital NHS Foundation Trust

Birmingham, , United Kingdom

Site Status

Croydon Health Services NHS Trust

London, , United Kingdom

Site Status

Barts Health NHS Trust

London, , United Kingdom

Site Status

Kingston Hospital NHS Foundation Trust

London, , United Kingdom

Site Status

Guy's and St Thomas' NHS Foundation Trust

London, , United Kingdom

Site Status

King's College Hospital NHS Foundation Trust

London, , United Kingdom

Site Status

Chelsea and Westminster Hospital NHS Foundation Trust

London, , United Kingdom

Site Status

St George's University Hospitals NHS Foundation Trust

London, , United Kingdom

Site Status

Manchester University NHS Foundation Trust

Manchester, , United Kingdom

Site Status

Oxford University Hospitals NHS Foundation Trust

Oxford, , United Kingdom

Site Status

The Royal Berkshire NHS Foundation Trust

Reading, , United Kingdom

Site Status

The Royal Wolverhampton NHS Trust

Wolverhampton, , United Kingdom

Site Status

Countries

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United Kingdom

References

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Dougall G, Franssen M, Tucker KL, Yu LM, Hinton L, Rivero-Arias O, Abel L, Allen J, Band RJ, Chisholm A, Crawford C, Green M, Greenfield S, Hodgkinson J, Leeson P, McCourt C, MacKillop L, Nickless A, Sandall J, Santos M, Tarassenko L, Velardo C, Wilson H, Yardley L, Chappell L, McManus RJ. Blood pressure monitoring in high-risk pregnancy to improve the detection and monitoring of hypertension (the BUMP 1 and 2 trials): protocol for two linked randomised controlled trials. BMJ Open. 2020 Jan 23;10(1):e034593. doi: 10.1136/bmjopen-2019-034593.

Reference Type BACKGROUND
PMID: 31980512 (View on PubMed)

Tucker KL, Mort S, Yu LM, Campbell H, Rivero-Arias O, Wilson HM, Allen J, Band R, Chisholm A, Crawford C, Dougall G, Engonidou L, Franssen M, Green M, Greenfield S, Hinton L, Hodgkinson J, Lavallee L, Leeson P, McCourt C, Mackillop L, Sandall J, Santos M, Tarassenko L, Velardo C, Yardley L, Chappell LC, McManus RJ; BUMP Investigators. Effect of Self-monitoring of Blood Pressure on Diagnosis of Hypertension During Higher-Risk Pregnancy: The BUMP 1 Randomized Clinical Trial. JAMA. 2022 May 3;327(17):1656-1665. doi: 10.1001/jama.2022.4712.

Reference Type RESULT
PMID: 35503346 (View on PubMed)

Chappell LC, Tucker KL, Galal U, Yu LM, Campbell H, Rivero-Arias O, Allen J, Band R, Chisholm A, Crawford C, Dougall G, Engonidou L, Franssen M, Green M, Greenfield S, Hinton L, Hodgkinson J, Lavallee L, Leeson P, McCourt C, Mackillop L, Sandall J, Santos M, Tarassenko L, Velardo C, Wilson H, Yardley L, McManus RJ; BUMP 2 Investigators. Effect of Self-monitoring of Blood Pressure on Blood Pressure Control in Pregnant Individuals With Chronic or Gestational Hypertension: The BUMP 2 Randomized Clinical Trial. JAMA. 2022 May 3;327(17):1666-1678. doi: 10.1001/jama.2022.4726.

Reference Type RESULT
PMID: 35503345 (View on PubMed)

Campbell HE, Chappell LC, McManus RJ, Tucker KL, Crawford C, Green M, Rivero-Arias O. Detection and Control of Pregnancy Hypertension Using Self-Monitoring of Blood Pressure With Automated Telemonitoring: Cost Analyses of the BUMP Randomized Trials. Hypertension. 2024 Apr;81(4):887-896. doi: 10.1161/HYPERTENSIONAHA.123.22059. Epub 2024 Jan 23.

Reference Type DERIVED
PMID: 38258566 (View on PubMed)

Hinton L, Hodgkinson J, Tucker KL, Rozmovits L, Chappell L, Greenfield S, McCourt C, Sandall J, McManus RJ. Exploring the potential for introducing home monitoring of blood pressure during pregnancy into maternity care: current views and experiences of staff-a qualitative study. BMJ Open. 2020 Dec 1;10(12):e037874. doi: 10.1136/bmjopen-2020-037874.

Reference Type DERIVED
PMID: 33262186 (View on PubMed)

Ashworth DC, Maule SP, Stewart F, Nathan HL, Shennan AH, Chappell LC. Setting and techniques for monitoring blood pressure during pregnancy. Cochrane Database Syst Rev. 2020 Jul 23;8(8):CD012739. doi: 10.1002/14651858.CD012739.pub2.

Reference Type DERIVED
PMID: 32748394 (View on PubMed)

Other Identifiers

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224978

Identifier Type: -

Identifier Source: org_study_id

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