Home monitoring of hypertension in pregnancy

HaMpton is an app that enables pregnant women to monitor their blood pressure at home and alerts them if they need to attend hospital for further assessment.

High blood pressure disorders complicate 10% of pregnancies and pre-eclampsia affects between 2% and 8%. Pre-eclampsia can be life-threatening for both mother and baby. Standard care pathways for women who have high blood pressure in pregnancy require frequent hospital visits, commonly two to three times a week, for blood pressure monitoring and urine testing.

HaMpton provides an alternative by enabling home blood‐pressure monitoring. Patients monitor and record their own blood pressure using a validated machine, with instructions from a healthcare professional on the frequency of monitoring and when to attend the hospital.

The app alerts women if they need to attend the hospital, and it also links with a hospital computer system where the data can be monitored by clinicians. The app also includes ‘trigger’ questions to help women monitor their condition.

Professor Asma Khalil, Consultant Obstetrician at St George’s, led the development after having the idea as a junior doctor. She says the app “has the potential to revolutionise the way we look after pregnant women”.

How was it developed?

The app was developed with the help of a Health Foundation grant. A pilot study was carried out with 108 women who were taught how to measure and record their blood pressure using a validated machine at home. A control group of 58 women was monitored in a clinic. There were no differences in adverse maternal, fetal, or neonatal outcomes.

Eligible patients were counseled and trained by a specialist midwife and provided with an automated home blood‐pressure machine and taught how to measure their blood pressure accurately and record readings in their notes or on the smartphone app

Who is using it?

Currently in use at St George’s Hospital in London. Professor Khalil says that there are plans to expand the idea into other areas, such as fetal heart monitoring.

Outcomes?

Professor Khalil says use of the app has led to a demonstrable improvement in patient experience by reducing their travel and childcare expenses and empowering women to become involved in their own care. This also reduced pressure on the day assessment unit, with a reduction of 334 appointments, and reduced the time of other appointments and saved 587.84 hours of midwife time.

NHS Innovation Accelerator reports the impact of HaMpton:

• 53% reduction in number of appointments for hypertension monitoring, and amount of time per appointment
• £300 average cost saving per patient per week according to basic health economic study
• £50 million potential annual cost saving if scaled up across the UK

An analysis by health economists found that use of HaMpton app can save up to 75% of the cost of traditional care for this condition.

St George’s senior midwife Jessica Davey said use of the app by patients allowed staff to manage their time better and it allows women more control of their care.

Clare Murray used the app during her pregnancy. She welcomed having the ability to check her blood pressure at home, saving three to four hospital visits a week. Another benefit was that she avoided aggravating her ‘white coat syndrome’, where just being in the hospital environment raises blood pressure.

CQC’s report on St Georges’ maternity services in 2016 noted that ‘there were many good examples of pioneering work and innovative practices such home monitoring of hypertension in pregnancy, using a mobile phone app’. Maternity services received a rating of outstanding for effectiveness.