A rapid review of telehealth in women with recent de novo hypertensive disease of pregnancy

Abstract

Hypertensive disorders of pregnancy pose significant risks to both maternal and fetal health. Postpartum hypertension, a common complication, often leads to emergency room (ER) visits or hospital readmissions. Despite the prevalence of these complications, there is a paucity of studies that focus on blood pressure monitoring in postpartum patients with de novo hypertensive disorders of pregnancy. This review aimed to address the gap by evaluating available evidence to compare telehealth monitoring with in‐person visits in preventing ER visits and hospital readmissions among postpartum patients with de novo hypertensive disorders of pregnancy. The study identified relevant studies by conducting a rigorous search strategy (Medline/OVID, the Cochrane Library, Scopus, and research registries such as the International Clinical Trials Registry Platform [ICTRP] and clinical trials) directed by the clinical information specialist. Two reviewers independently screened titles and abstracts, resolving discrepancies with the assistance of a third reviewer. Data extraction followed standardized protocols, and risk of bias assessments were conducted using appropriate tools. This rapid review synthesized evidence from 11 studies on telehealth for women with recent de novo hypertensive disorders of pregnancy. Findings highlighted that telemonitoring led to earlier blood pressure documentation and intervention, reduced disparities in blood pressure measurement, decreased hypertension‐related readmissions, higher rates of postpartum antihypertensive treatment initiation, and increased patient satisfaction. Telehealth emerges as a promising tool for managing postpartum hypertension among women with recent de novo hypertensive disorders of pregnancy

1. INTRODUCTION

Hypertensive disorders of pregnancy represent a significant threat to maternal health, predisposing affected individuals to various cardiovascular‐related complications. ¹ Despite considerable advancements in obstetric care, these conditions persist as significant contributors to maternal mortality rates globally. Notably, in the United States alone, it is estimated that approximately 7% of maternal deaths are attributable to pregnancy‐related hypertension, with a substantial proportion of these fatalities occurring postpartum, as reported by the Centers for Disease Control. ² The immediate postpartum period presents a critical window of vulnerability, as blood pressure levels tend to peak within the first week after delivery, placing women at heightened risk of hypertension‐related complications such as stroke and seizures upon discharge from healthcare facilities. Recognizing the significance of this risk, the American College of Obstetricians and Gynecologists advocates for implementing postpartum blood pressure monitoring protocols, recommending assessments at 72 h post‐delivery and again within 7−10 days. ³

Traditional or routine management strategies in postpartum care typically involve patients visiting clinical settings for in‐person blood pressure evaluations. However, emerging technological innovations have paved the way for alternative approaches, notably telehealth, which revolutionize the delivery of healthcare services. In contrast to conventional methods, telehealth empowers patients to conduct blood pressure measurements autonomously using electronic devices. The subsequent transmission of these data is facilitated through diverse communication channels, including but not limited to text messaging platforms, email systems, manual input on dedicated websites, and automated data forwarding mechanisms from specialized blood pressure devices. ⁴ This paradigm shift in healthcare delivery holds the potential to enhance patient engagement, improve accessibility to healthcare services, and optimize the management of hypertensive disorders of pregnancy during the critical postpartum period.

This rapid review aims to evaluate the effectiveness and feasibility of telehealth as compared to traditional in‐person assessments in managing postpartum hypertension in women with recent de novo hypertensive disease of pregnancy.

2. METHODS

The study extensively searched multiple databases, including Medline/OVID, the Cochrane Library, Scopus, and research registries such as the International Clinical Trials Registry Platform (ICTRP) and clinicaltrials.gov. This search was supplemented by manual searches of reference lists, related articles, and communication with authors and professional organizations. This search strategy was meticulously crafted using relevant Medical Subject Headings (MeSH) terms and keywords related to the postpartum period, blood pressure, hypertensive disorders, and telemedicine to ensure inclusivity and comprehensiveness.

Initially, the study focused on meta‐analyses, systematic reviews, randomized controlled trials, and high‐quality cohort and case‐control studies involving postpartum women with de novo hypertensive disorders of pregnancy. It excluded studies involving pregnant or postpartum women with hypertensive disorders before 20 weeks of gestation. Two independent reviewers (ST and ED) screened titles and abstracts from multiple electronic databases (PubMed, MEDLINE, Embase, and the Cochrane Library) from inception to April 11, 2024 (Figure 1). Articles were selected based on predefined eligibility criteria, explicitly targeting studies on telehealth for managing postpartum hypertensive disorders. The information specialist (DN) obtained full‐text articles of potentially eligible studies for a thorough review to assess suitability for inclusion in the systematic review.

FIGURE 1.

Adapted PRISMA flow diagram showing the flow of study selection for this review, including searches of databases and other sources.

Two reviewers (ST and ED) performed data extraction independently using a standardized sheet, which was piloted and refined before the study. All screened and extracted data were independently verified by TA. The risk of bias in included studies was assessed by two independent reviewers (ST and ED) using tools tailored to each study design: the Cochrane Risk of Bias 2 (RoB 2) tool for randomized controlled trials, the Risk of Bias in Non‐randomized Studies of Interventions (ROBINS‐I) tool for non‐randomized studies, the Risk of Bias in Systematic Reviews (ROBIS) tool for systematic reviews and meta‐analyses, and the Newcastle‐Ottawa Scale (NOS) for cohort studies. Disagreements in data extraction and risk of bias assessment were resolved through discussion, with a third reviewer (TA) consulted when necessary. Table 1 contains the results of the risk of bias evaluation.

TABLE 1.

Risk of bias assessment for included studies.

S/N	Author	Title of paper	Bias assessment tool	Level of bias
1	Hirshberg et al. 5	Association of a remote blood pressure monitoring program with postpartum adverse outcomes	ROBINS‐I	Moderate
2	Arkerson et al. 6	Remote monitoring compared with in‐office surveillance of blood pressure in patients with pregnancy‐related hypertension	RoB 2	Low
3	Forna et al. 7	Improving obstetric and perinatal outcomes with a remote patient monitoring program for hypertension in a large integrated care system	ROBINS‐I	Moderate
4	Steele et al. 8	Postpartum home blood pressure monitoring, systematic review	ROBINS‐I	Moderate
5	Hoppe et al. 9	Telehealth with remote blood pressure monitoring compared with standard care for postpartum hypertension	ROBINS‐I	Moderate
6	Niu et al. 10	Cost‐effectiveness of telehealth with remote patient monitoring for postpartum hypertension	ROBINS‐I	Moderate
7	Countouris et al. 11	Feasibility of utilizing telehealth in a multidisciplinary postpartum hypertension clinic	Newcastle‐Ottawa quality assessment scale	Low
8	Cairns et al. 12	Self‐management of postnatal hypertension: The SNAP‐HT trial	RoB 2	Low
9	Kitt et al. 13	Short‐term postpartum blood pressure self‐management and long‐term blood pressure control: A randomized controlled trial	RoB 2	Low
10	Hirshberg et al. 14	Comparing standard office‐based follow‐up with text‐based remote monitoring in the management of postpartum hypertension: A randomised clinical trial	RoB 2	Low
11	Hirshberg et al. 15	Text message remote monitoring reduced racial disparities in postpartum blood pressure ascertainment	RoB 2	Low
12	Kitt et al. 16	Long‐term blood pressure control after hypertensive pregnancy following physician‐optimized self‐management	RoB 2	Low

Given the heterogeneous nature of outcome reporting, a narrative synthesis approach was adopted to summarize findings. Efforts were made to contact authors for missing data, notably when crucial information was lacking from published reports, but the study did not receive any responses.

This study modified this rapid review to adhere to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines, ensuring transparent and comprehensive reporting (Figure 1). The study protocol, including the search strategy, selection criteria, and data extraction procedures, was pre‐established and registered with Northwestern Feinberg School of Medicine (FSM)’s PRISM (DOI: 10.18131/dpchh‐29m16). The online supplement contains the search strategy, data extraction forms, and comprehensive risk of bias results.

3. RESULTS

3.1. Study characteristics

The initial search strategy for this review yielded 881 papers. After eliminating 314 duplicates and other ineligible records, 567 unique articles remained. These were screened using predetermined inclusion criteria, resulting in the exclusion of 537 studies. Thirty reports were sought for retrieval, and 15 of the retrieved reports were further excluded for not meeting the inclusion criteria. Four of the 15 reports assessed for eligibility were excluded for various reasons (Figure 1), while one additional paper was identified through backward citation.

The final selection comprised 12 papers, summarized in Tables 1 and 2. Nine of these studies were conducted in clinics and hospitals across the United States, while the remaining three were based in NHS hospitals in the United Kingdom. The studies employed diverse methodological approaches, including masked and unmasked randomized control trials, non‐randomized control trials, prospective cohort studies, and secondary analyses of existing data. Participant allocation across the studies primarily followed a one‐to‐one ratio between control and intervention groups. Details of the data extracted and the results of the bias assessments are provided in the online Supplementary Information.

TABLE 2.

Study characteristics of included studies.

Authors	Country	Study design	Sample size	Main results
Hirshberg et al. 5	USA	Retrospective cohort study	5454	The remote BP monitoring group had lower composite adverse outcomes and reduced ED visits and readmissions
Arkerson et al. 6	USA	Randomized controlled trial	202	The telehealth arm had significantly higher rates of blood pressure ascertainment within 10 days of discharge
Forna et al. 7	USA	Matched retrospective cohort study	154	The telehealth arm had a higher rate of post‐hospital discharge BP within 20 days and were more likely to use antihypertensives postpartum
Steele et al. 8	USA	Systematic review	13 studies	Telehealth improves BP ascertainment and reduces disparities in BP ascertainment between Black and non‐Black patients
Hoppe et al. 9	USA	Non‐randomized controlled trial	1009	The telehealth arm had lower hypertension‐related hospital readmissions over the 6‐week postpartum period
Niu et al. 10	USA	Cost‐effectiveness study; secondary analysis from parent trial	1009	Telehealth was more cost‐effective than standard office visits
Countouris et al. 11	USA	Observational study	140	Telehealth visits showed no significant difference in age, race, or BMI compared to in‐person visits
Cairns et al. 12	UK	Unmasked randomized controlled trial	91	Telehealth leads to better diastolic BP control at 6 weeks postpartum
Kitt et al. 13	UK	Prospective randomized controlled trial (follow‐up of SNAP‐HT)	63	Telehealth leads to lower 24‐h diastolic BP
Hirshberg et al. 14	USA	Prospective randomized controlled trial	206	Telehealth leads to higher BP ascertainment
Hirshberg et al. 15	USA	Planned secondary analysis of an RCT	206	Telehealth leads to reduced racial disparity in BP ascertainment
Kitt et al. 16	UK	2‐group; parallel, randomized, open‐blinded endpoint (PROBE) study	220	Telehealth leads to lower mean adjusted 24‐h blood pressure

3.2. Telemonitoring leads to lower blood pressure values

The studies reviewed in this paper provide evidence of significant reductions in mean BP for those utilizing telemonitoring compared to usual care. Cairns and colleagues observed a notable reduction in mean BP among patients using telemonitoring, with the most significant decreases occurring at six weeks postpartum. They reported that the adjusted mean systolic BP difference was −5.2 mmHg (95% CI, −9.3 to −1.2), while the adjusted mean diastolic BP difference was −5.8 mmHg (95% CI, −9.1 to −2.5). The mean BP was calculated based on measurements taken during the researchers' follow‐up home visits to women in both the intervention and control groups. These results indicate that telemonitoring can improve BP control in the early postpartum period. Kitt and colleagues extended the observation period to 36 months postpartum, finding that women in the telemonitoring group had significantly lower 24‐h diastolic BP than the usual care group, with a mean difference of −7.0 mmHg (95% CI, −10.7 to −4.2; p < .001). Additional reductions were noted in diurnal diastolic BP by 5.3 mmHg (95% CI, −8.6 to −2.0; p = .002) and nocturnal diastolic BP by 7.8 mmHg (95% CI, −11.9 to −3.7; p < .001). This suggests that telemonitoring can offer sustained benefits over a longer term.

Furthermore, in a second trial by Kitt and colleagues, known as the POP‐HT trial, the effectiveness of telemonitoring in maintaining lower BP readings at 6–9 months postpartum was corroborated. At a mean of 249 days postpartum, the telemonitoring group exhibited significantly lower mean adjusted 24‐h BP (114.0/71.2 mmHg) compared to the control group (120.3/76.6 mmHg; p < .001). This difference was consistent across clinic BP readings and 24‐h ambulatory systolic, diastolic, nocturnal, and diurnal BP measurements, all showing statistically significant reductions in the telemonitoring group.

3.3. Telemedicine may lead to lower hypertension‐related readmissions

Continuing from the discussion on the effectiveness of telemonitoring in managing blood pressure (BP), telemonitoring has a role in reducing hypertension‐related readmissions and potential risks. In the studies reviewed in this paper, Hirschberg and colleagues found that patients in the telemonitoring group had significantly fewer hypertension‐related readmissions than those in the office‐based follow‐up group (0% vs. 3.9%, p = .04). Kitt and colleagues demonstrated a substantial reduction in hypertension‐related hospital readmissions in the telemonitoring group compared to standard office visits (8% vs. 29%, p < .01). The systematic review by Steele and colleagues showed that home BP monitoring may reduce hypertension‐related hospital readmissions. Similarly, Hoppe and colleagues observed a lower risk of hypertension‐related readmissions among those utilizing telehealth versus those receiving standard care (0.5% vs. 3.7%, RR: 0.12, 95% CI: 0.01–0.96, p = .045). Despite these promising results, Hoppe and colleagues found no statistically significant difference in hypertension‐related emergency department visits or triage between the telemonitoring and standard care groups (4.6% vs. 6.0%, RR: 0.81, 95% CI: 0.36–1.80, p = .81).

3.4. Telemonitoring may lead to an increased likelihood of initiating postpartum antihypertensive treatment

Hoppe and colleagues found no significant difference in the proportion of patients receiving antihypertensive medications between the telemonitoring and standard care groups (26.6% vs. 17.3%, RR: 1.03, 95% CI: 0.74–1.44, p = .866), while other studies observed different trends. For example, Kitt and colleagues reported a higher rate of antihypertensive medication prescriptions in the telemonitoring group compared to the standard office visit group one week after discharge (1.5 vs. 0.2, p = .01). Similarly, Arkerson and colleagues observed a trend toward more frequent initiation or up‐titration of antihypertensive medications in the telehealth group compared to the standard care group (9.4% vs. 6.9%, p = .530). However, this difference was not statistically significant. Similarly, Forna and colleagues found that patients in the telehealth group were more likely to be taking antihypertensives postpartum (51.9% vs. 40.9%, RR 1.27, 95% CI 1.15−1.40, p < .01), and were also more likely to be on multiple antihypertensive medications (16.9% vs. 12.0%, RR 1.41, 95% CI 1.13−1.77, p < .01).

3.5. Telemonitoring leads to earlier blood pressure documentation and intervention

Most studies reviewed in this paper demonstrated that telemonitoring significantly improves the likelihood of postpartum patients' blood pressure being measured within the critical early days after delivery. Hirshberg and colleagues found that 92.2% of patients in the telemonitoring group had at least one blood pressure measurement within the first 10 days postpartum, significantly higher than the 43.7% in the standard office visit group (p < .001). This finding aligns with Hoppe and colleagues’ study, where 94.4% of telemonitoring participants had at least one BP measurement within 10 days of delivery, compared to 60.3% in the standard care group (RR: 1.59, 95% CI 1.36−1.77, p < .001). Additional studies reviewed in this paper reinforce these results. Arkerson and colleagues found that patients in the telemonitoring group had significantly higher rates of blood pressure ascertainment within 10 days of discharge compared to those receiving standard care (91.7% vs. 58.4%, p < .001). Forna and colleagues showed a comparable trend, with 91.1% of patients in the telemonitoring group having their blood pressure measured within the first 20 days after delivery, versus 58.5% in the control group (RR 1.56, 95% CI 1.47−1.65, p < .01). These results, drawn from the studies reviewed in this paper, are consistent with the systematic review by Steele and colleagues, which revealed a moderate level of evidence suggesting that home blood pressure monitoring improves the reporting of BP measurements and likely results in higher patient adherence compared to usual care. These findings indicate that telemonitoring can be a valuable tool in promoting compliance with postpartum blood pressure checks, potentially reducing the risk of complications through early detection and management.

3.6. Telemonitoring may reduce disparities in blood pressure measurement

The benefits of telemonitoring extend beyond increased adherence, as evidenced by some studies focusing on racial disparities and logistical factors affecting postpartum care. Hirshberg and colleagues’ research highlighted significant discrepancies in postpartum blood pressure readings between non‐Black and Black patients across different monitoring approaches in the studies reviewed in this paper. In the traditional office‐based group, only 70% of non‐Black patients and 33% of Black patients had their postpartum blood pressure checked. However, the telemonitoring group saw significantly higher rates, with 91% of non‐Black patients and 93% of Black patients monitoring their blood pressure. Another study by Countouris and colleagues compared virtual and in‐person postpartum care and found no significant differences in age, race, or area deprivation index (ADI) between the two groups. However, the distance from patients' homes to the clinic differed significantly. Patients in the in‐person group lived closer to the clinic, with a mean distance of 11.3 miles. In comparison, the virtual group had a mean distance of 11.6 miles, indicating a statistically significant difference. These findings align with the systematic review by Steele and colleagues, suggesting that home BP monitoring probably reduces racial disparities in BP ascertainment with moderate strength of evidence. This further supports the idea that telemonitoring, by offering more convenience, can lead to increased frequency of blood pressure readings and potentially improve postpartum care outcomes.

3.7. Patient satisfaction with telemonitoring

Transitioning from investigating telemonitoring's impact on addressing disparities, Hirshberg and colleagues found high satisfaction levels among participants using telemonitoring, all of whom expressed willingness to recommend the program. Interestingly, they rated the importance of face‐to‐face communication lower than those in standard office visits, indicating telemonitoring effectively meets patients' needs without extensive in‐person interaction. However, Kitt and colleagues’ trial showed no significant Quality‐of‐Life score differences between telemonitoring and standard care groups, suggesting while telemonitoring offers convenience and autonomy, it may not directly impact the overall quality of life. These combined results underscore telemonitoring's positive experiences and benefits in postpartum care, especially for women with hypertensive disorders, enhancing patient autonomy and satisfaction while seamlessly integrating into routine care. In a study on women's experiences with blood pressure telemonitoring, Thomas and colleagues found that only 1.6% (2/128) found usage instructions very or extremely difficult, 0.9% (1/128) felt the technology demanded extreme mental effort, 59% (75/127) reported the technology easily fitting into their lifestyle, 80% (34/43) found help readily accessible, and 80% (101/127) felt confident using the devices.

3.8. Telemonitoring is cost‐effective and feasible

Following the discussion on telemonitoring's influence on patient satisfaction and convenience, let us now consider its impact on cost‐effectiveness, feasibility, and patient acceptance in managing postpartum blood pressure. Telemonitoring has proven to be an efficient approach, offering significant cost savings. A cost comparison study by Niu and colleagues showed that telehealth patients incurred lower care costs, with an average expense of $515 per patient compared to $608 for those receiving standard care. Additionally, Quality‐Adjusted Life Years (QALYs) were slightly higher with telemonitoring, measuring 41.76 compared to 41.70 in the standard care group. This finding suggests that telemonitoring not only reduces costs but may also contribute to an improved quality of life. Further emphasizing cost savings, telehealth interventions also had lower admission costs, with telemonitoring patients averaging $10 999, compared to $14 401 for those in standard care. These cost benefits are significant in healthcare management, particularly for postpartum care, where effective monitoring can lead to better outcomes and reduced hospital readmissions. Beyond cost‐effectiveness, telemonitoring has demonstrated feasibility for long‐term postpartum care. Hauspurg and colleagues conducted a randomized controlled trial with an impressive 87% retention rate over a 1‐year postpartum period, indicating that telemonitoring can sustain patient engagement over extended periods. This high retention rate highlights the potential for telemonitoring to be a reliable and lasting solution for managing postpartum blood pressure. These findings suggest that telemonitoring is generally user‐friendly and provides support that fosters continued use. Overall, these results demonstrate the multifaceted benefits of telemonitoring, from cost savings and feasibility to high patient acceptance. This indicates that telemonitoring could be a practical and sustainable approach to managing postpartum blood pressure, with potential applications in broader healthcare settings.

4. DISCUSSION

4.1. Significant findings

The study shows that telehealth in the postpartum period can significantly enhance patient outcomes and healthcare delivery. Telehealth led to an increased frequency of blood pressure measurements, resulting in sustained reductions in mean blood pressure levels. This reduction in hypertension‐related hospital readmissions underscores telemonitoring's positive impact on effectively managing cardiovascular outcomes during the critical post‐pregnancy phase. Additionally, telehealth was associated with higher prescription rates of antihypertensive medications, indicating better hypertension management for at‐risk postpartum patients. Economically, telehealth demonstrated cost savings compared to conventional care approaches due to reduced hospital readmissions, fewer medical interventions, and optimized resource utilization. Moreover, telehealth has proven to be practical and feasible in real‐world settings, offering a convenient and accessible means of monitoring postpartum patients at risk of adverse cardiovascular outcomes. Participants in telehealth programs reported high satisfaction levels, reflecting strong acceptance and engagement with this innovative approach to healthcare delivery.

4.2. Results in the context of what is known

Strict blood pressure monitoring in the postpartum period is essential for mitigating potential cardiovascular complications, as substantiated by Miller and colleagues and Arkerson and colleagues ⁶ , ¹⁷ In this context, telehealth utilization emerges as a promising and scientifically grounded approach. In other areas of cardiology, like heart failure, telehealth demonstrates notable efficacy in reducing hospital readmissions, shortening hospital stays, and yielding significant cost savings. ¹⁸

Examining the psychological dimensions of telehealth, Cairns and colleagues found that individuals in the telemonitoring group exhibited a stronger sense of control than those receiving standard care at the 4‐week and 6‐month evaluations, with adjusted differences of 0.6 and 0.7, respectively. ¹⁹ The adjusted differences between groups were estimated from the analysis of qualitative experience interviews using a mixed‐effects repeated measures regression model. ¹⁹ This model included fixed effects for outcome, randomized group, time, and their interaction while also adjusting for recruitment site and initial screening scores. ¹⁹ Patient acceptance of telemonitoring has also been encouraging. Thomas and colleagues discovered that 80% of women felt confident using telemonitoring devices, and 59% indicated that the technology easily fit into their lifestyle. Furthermore, 80% of participants thought they could access help when needed, while only a tiny fraction, 1.6%, found the technology extremely difficult to use. ²⁰ This emphasizes the significance of patient satisfaction despite no notable variations in confidence, communication, knowledge, or shared responsibility between the telemonitoring and standard care cohorts. The heightened sense of control among telemonitoring participants is a crucial factor.

Additionally, Janssen and colleagues echoed positive outcomes, emphasizing the convenience and effectiveness of remote blood pressure (BP) monitoring initiatives. ²¹ Nearly half of the respondents reported positive experiences, citing the convenience of receiving text updates and the increased focus on BP management. ²¹ Furthermore, most participants expressed readiness to recommend the program to others. Notably, the study illustrated the seamless integration of telemonitoring into routine postpartum care, with over 80% of participants establishing a primary care provider and more than half scheduling follow‐up appointments within 2−4 weeks. ²¹

Telehealth serves as a vital tool in addressing disparities in healthcare by providing flexible and accessible care options. As cited by Hirshberg and colleagues, only 33% of Black females had their blood pressure checked in the postpartum period, compared to 70% of non‐Black females. ¹⁵ Telehealth can effectively bridge this disparity gap by reducing logistical and socioeconomic barriers. Black women, who may encounter significant challenges in accessing postpartum care due to logistical or socio‐economic constraints, can benefit from comprehensive programs that incorporate telehealth, potentially reducing the risks of maternal and fetal complications post‐pregnancy.. ²² Additionally, telemedicine diminishes the necessity for frequent in‐person visits, a particularly advantageous aspect for individuals residing in underserved areas or facing transportation and childcare issues. Telehealth initiatives are crucial in promoting adherence to postpartum care among Black women and underserved populations.. ²² For instance, remote blood pressure (BP) monitoring empowers patients to monitor their BP at home and engage with healthcare providers without costly or time‐consuming clinic visits. This approach is precious for Black women, who statistically exhibit lower attendance rates for in‐person follow‐up appointments, likely due to structural inequities within the healthcare system.

These findings resonate with existing research, affirming the practicality of integrating telehealth into routine practice and showcasing its non‐inferiority compared to traditional in‐office visits. Studies such as Drewry and colleagues and Jongsma and colleagues underscore this advantage, highlighting the significant levels of acceptance, user‐friendliness, and satisfaction among expectant mothers regarding remote patient monitoring (RPM) adoption, which aligns with the outcomes of this swift examination. ²⁰ , ²³ For instance, Janssen and colleagues found that 96.5% of participants in their telehealth program sent at least one blood pressure measurement via text within 10 days after leaving the hospital. ²¹ Similarly, Janssen and colleagues observed a 5% rate of readmissions related to postpartum hypertension in their monitoring program, although the specific causes were not explicitly outlined. ²¹

Moreover, the early identification facilitated by RPM, as deduced from this review, holds significant clinical importance, providing timely avenues for intervention and potentially mitigating adverse consequences. ²¹ This notion aligns with suggestions such as those advocated by Hirshberg and colleagues, emphasizing the importance of systematic blood pressure monitoring at defined intervals during the postpartum period. ²⁴ While telemonitoring shows promise in postpartum care, its implementation faces several challenges. Issues regarding insurance coverage, particularly within Medicaid, may lead to disparities in access to telemonitoring services based on income levels. ²⁵ Additionally, limited internet access in underserved populations and substantial initial investments for health systems present additional hurdles in adopting telehealth technologies. ²⁶ Ensuring patient adherence to telemonitoring protocols and addressing usability concerns, particularly among older individuals with cognitive impairments, are critical considerations for successful implementation in postpartum care.

4.3. Clinical implications

The studies discussed here indicate that telehealth is a valuable tool for managing postpartum blood pressure, offering several clinical advantages. First, telehealth leads to earlier and more consistent blood pressure documentation, facilitating timely interventions. The increased frequency and consistency of blood pressure measurements could reduce postpartum complications, such as hypertension‐related readmissions. Telehealth has shown promise in reducing disparities in blood pressure measurement among different racial groups, suggesting it could play a role in addressing healthcare inequalities. The lower costs and higher retention rates associated with telehealth make it a feasible option for long‐term postpartum care, demonstrating its capacity to sustain patient compliance. The high patient satisfaction and acceptance rates support its integration into routine postpartum care, providing efficient and effective telehealth.

4.4. Research implications

While telehealth has demonstrated cost‐effectiveness and feasibility, further research is needed to explore its impact on clinical outcomes in greater detail. This includes examining the long‐term effects of telehealth on postpartum hypertension and related complications, as well as identifying potential risks or adverse events associated with telehealth. Additionally, more studies are needed to understand the mechanisms underlying the reduction in blood pressure values observed in telehealth groups and the impact on medication compliance and adjustments. The role of telehealth in reducing health disparities requires further investigation to determine its effectiveness across different demographic groups and geographic locations. Given the varying results on telehealth's influence on postpartum antihypertensive treatment initiation, more research is required to assess its impact on clinical decision‐making and treatment patterns. Finally, the mixed results on patient satisfaction and quality‐of‐life outcomes suggest a deeper exploration of patient‐reported experiences and the factors influencing their satisfaction with telemonitoring. Addressing these research gaps will help optimize telemonitoring practices and ensure their broader adoption as a reliable and efficient tool in postpartum care.

4.5. Strengths and limitations of this study

The rapid review of telehealth in women with recent de novo hypertensive disease of pregnancy presents several strengths. Firstly, it offers a timely synthesis of existing literature, providing a comprehensive overview of the efficacy and feasibility of telehealth strategies in managing postpartum hypertension. By synthesizing evidence from multiple studies, the review allows for a quick and accessible understanding of the current knowledge in this critical area of postpartum care. Additionally, the review likely contributes to bridging the gap between research and clinical practice by highlighting the potential benefits of telehealth technologies in improving patient outcomes and healthcare delivery.

However, rapid review also has inherent limitations that should be acknowledged. Rapid reviews, while offering a quicker synthesis of the available evidence, carry intrinsic limitations that are crucial to address. The speed of the review process often means that the depth of analysis and the thoroughness of the evidence synthesis are somewhat constrained. This can lead to unintentional oversights or omissions of significant findings from individual studies, potentially affecting the robustness of the review's conclusions. A limited number of included studies can restrict the generalizability of the findings, especially if the studies vary in terms of populations, interventions, or outcomes. Additionally, the rapid review format often does not allow for a detailed assessment of the quality of the included studies, raising questions about the reliability and validity of the synthesized evidence.

The studies included in this rapid review also have specific limitations. Short follow‐up periods, common in many studies, make assessing the long‐term effects of self‐management strategies difficult, emphasizing the need for longer follow‐ups to determine the sustainability of intervention benefits accurately. Additionally, most of these studies were conducted in large academic centers, raising concerns about the feasibility of replicating similar results in smaller, rural, or non‐teaching centers. Non‐randomized trials, frequently part of these studies, can introduce selection bias, especially when acquiring and utilizing telemonitoring technology. Lastly, the limited availability of remote translator services could impact the inclusivity and broader applicability of the study findings.

5. CONCLUSIONS

This review underscores the potential of telehealth‐based blood pressure monitoring as a valuable tool in postpartum care for women with hypertensive disease of pregnancy (HDP), effectively overcoming socioeconomic barriers associated with traditional in‐person follow‐up visits. Future investigations should explore the applicability of telemedicine‐based interventions in rural areas or smaller healthcare centers with limited resources. Moreover, conducting RCT studies with more extended follow‐up periods and assessing the cost‐effectiveness of telemedicine interventions can provide crucial insights into their economic viability and long‐term sustainability within healthcare systems. Lastly, studies encompassing patients with government insurance, such as Medicaid, are essential to mitigate disparities in postpartum care for women with HDP. The need to conduct new RCT with stronger data will help us understand and hopefully shape the practice to help the population most in need better.

AUTHOR CONTRIBUTIONS

Toluwalase Awoyemi conceptualized and supervised this review article. Samira Teeri and Emmanuel Daniel contributed to writing the original draft. Samira Teeri also handled data curation, formal analysis, and reviewing the manuscript. All authors contributed to the review and editing. while Denise Nunes contributed to writing the review and editing, as well as project administration.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflicts of interest.

Supporting information

Supporting information

Awoyemi T, Teeri S, Daniel E, et al. A rapid review of telehealth in women with recent de novo hypertensive disease of pregnancy. J Clin Hypertens. 2024;26:1015–1023. 10.1111/jch.14886

DATA AVAILABILITY STATEMENT

No new data was generated in this study.