Remote blood pressure management following hypertensive pregnancy was associated with lower postpartum blood pressure, according to a systematic review and meta-analysis. Pharmaceutical and nutraceutical interventions did not show statistically significant reductions in blood pressure.
Researchers analyzed 34 manuscripts representing 32 studies and 3,558 patients with hypertensive disorders of pregnancy, identified through six databases searched from inception through June 18, 2025. Twelve studies were included in meta-analyses of blood pressure outcomes, with most follow-up limited to the early postpartum period.
In pooled analyses, postnatal remote blood pressure management—typically involving home monitoring combined with physician-guided treatment—was associated with lower systolic and diastolic blood pressure at both 1 to 6 weeks postpartum and 6 weeks to 1 year postpartum. At the later time point, systolic blood pressure was lower by about 8 mmHg and diastolic blood pressure by about 6 mmHg. These interventions combine patient self-monitoring with timely physician management, which may contribute to greater blood pressure control than single-component approaches.
By contrast, antenatal and postnatal pharmaceutical and nutraceutical interventions did not produce statistically significant differences in systolic or diastolic blood pressure in pooled analyses, with substantial variability across studies. There were insufficient data to evaluate lifestyle interventions in meta-analysis.
The certainty of evidence was moderate for remote blood pressure management and antenatal pharmaceutical and nutraceutical interventions, and low for postnatal pharmaceutical and nutraceutical interventions.
Evidence for secondary outcomes was limited. A small number of studies assessed cardiovascular structure and function, with consistent improvements in diastolic function and some evidence of favorable left ventricular remodeling, although findings were otherwise heterogeneous. Clinical outcomes such as stroke, heart failure, and kidney events were rarely reported and involved small numbers of events.
The analysis was limited by short follow-up and variability across studies. Nearly half of included studies reported outcomes within 1 week postpartum, and few extended beyond 6 weeks. No high-quality randomized controlled trials evaluated long-term cardiovascular outcomes, and no studies assessed interventions spanning both antenatal and postnatal periods.
Even modest reductions in blood pressure may be clinically meaningful, as prior evidence suggests a 5 mmHg reduction is associated with lower long-term cardiovascular risk.
“There is a paucity of evidence around peripartum interventions and their effect on modifying cardiovascular risk through blood pressure reduction,” wrote Annabelle L Frost, MBBS, of the University of Oxford, and colleagues.
Disclosures: The study reported no funding. One author reported support for attending meetings, and another reported grants, consulting fees, speaker fees, advisory roles, patents, and leadership roles; the remaining researchers reported no competing interests.
