{ "abstract": "Background\n\nHypertensive disorders of pregnancy affect around 10% of pregnant women and can continue following childbirth. Such hypertension that persists postnatally can be unpredictable and may have long-term health consequences but care can be sub-optimal with poor support as women transition from maternity to community services. However, there is little evidence to guide best practice for managing postnatal hypertension, and these gaps in evidence and care disproportionately affect women from minoritised ethnic and socioeconomically disadvantaged backgrounds. Previous work suggests self-management where women self-monitor blood pressure (BP) and self-titrate medication, overseen by clinicians, could improve BP control in the short and long term but has been limited to single geographical areas. The aim of the SNAP2 trial is to evaluate the clinical and cost effectiveness of a self-management intervention at scale.Methods\n\nSNAP2 is a multi-centre unblinded randomised controlled trial. A planned sample of at least 628 participants across England with any pregnancy hypertension will be randomised within 7 days post birth to a digitally-supported self-management intervention, including self-monitoring of BP and clinician-guided titration of anti-hypertensive medication, or usual care. A cross-cutting theme is evaluating how health equity can best be ensured in postnatal hypertension management. The primary outcome is the difference in mean daytime ambulatory diastolic BP between intervention and usual care, measured between 22 to 39 weeks postpartum. Secondary outcomes include other measures of BP, maternal quality-of-life, medication adherence, adverse outcomes and readmission to hospital up to one year after birth. A qualitative process evaluation will explore how the intervention is implemented and integrated into women's lives and clinical pathways. An economic analysis will evaluate within-trial cost and outcomes and long-term economic modelling.Discussion\n\nThe SNAP2 trial will provide essential data on the clinical and cost-effectiveness of a self-management intervention that, if proven effective, could improve current sub-optimal postnatal care for BP management. In-depth qualitative and equity data will provide important insight to inform potential implementation. Throughout the manuscript, in our references to women, we encompass all birthing people. CLINICAL TRAIL NUMBER: https://doi.org/10.1186/ISRCTN11042045 .", "abstract_shown": true, "affiliations": [ "Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom. lucy.goddard@phc.ox.ac.uk.", "Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.", "Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.", "Maternal and Fetal Health Research Centre, University of Manchester, Manchester, United Kingdom.", "Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom.", "National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.", "Department of Women and Children's Health, Kings College London, London, United Kingdom.", "Action on Pre-eclampsia charity, Worcestershire, United Kingdom.", "Department of Cardiovascular Sciences, Leicester British Heart Foundation Centre of Research Excellence, University of Leicester, Leicester, United Kingdom.", "The Motherhood Group, London, United Kingdom.", "Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom.", "Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom.", "School of Health and Medical Sciences, City St George's, University of London, London, United Kingdom.", "School of Psychological Science, University of Bristol, Bristol, United Kingdom.", "Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom.", "NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom.", "School of Psychology, University of Southampton, Southampton, United Kingdom.", "University of Brighton and University of Sussex, Brighton and Sussex Medical School, Brighton, United Kingdom." ], "article_type": "research article", "arxiv": null, "author_total": 30, "authors": [ { "affs": [ 0 ], "name": "Lucy Goddard", "orcid": "0000-0003-3505-2399" }, { "affs": [ 1 ], "name": "Ellie Newbury" }, { "affs": [ 2 ], "name": "Katherine Tucker" }, { "affs": [ 3 ], "name": "Natalie Barry" }, { "affs": [ 4 ], "name": "Debra Bick" }, { "affs": [ 5 ], "name": "Helen Campbell" }, { "affs": [ 6 ], "name": "Lucy C Chappell" }, { "affs": [ 1 ], "name": "Paphapisa Chotthanawathit" }, { "affs": [ 1 ], "name": "Kate Corfield" }, { "affs": [ 7 ], "name": "Marcus Green" }, { "affs": [ 8 ], "name": "Pankaj Gupta" }, { "affs": [ 2 ], "name": "Lisa Hinton" }, { "affs": [ 9 ], "name": "Sandra Ignew" }, { "affs": [ 1 ], "name": "Nicola Kenealy" }, { "affs": [ 10 ], "name": "Paul Leeson" }, { "affs": [ 2 ], "name": "Rosa Mackay" }, { "affs": [ 11 ], "name": "Lucy Mackillop" }, { "affs": [ 12 ], "name": "Christine McCourt" }, { "affs": [ 1 ], "name": "Kate Moon" }, { "affs": [ 3 ], "name": "Jenny Myers" }, { "affs": [ 13 ], "name": "Cynthia Ochieng" }, { "affs": [ 6 ], "name": "Hannah Rayment-Jones" }, { "affs": [ 5 ], "name": "Oliver Rivero-Arias" }, { "affs": [ 14, 15 ], "name": "Cristian Roman" }, { "affs": [ 1 ], "name": "Milensu Shanyinde" }, { "affs": [ 14 ], "name": "Mayue Shi" }, { "affs": [ 14 ], "name": "Lionel Tarassenko" }, { "affs": [ 13, 16 ], "name": "Lucy Yardley" }, { "affs": [ 1 ], "name": "Ly-Mee Yu" }, { "affs": [ 17 ], "name": "Richard J McManus" } ], "bibtex": "https://research.draconitic.com/paper/fj2qknn3d0dvk.bib", "cited_by": 0, "doi": "10.1186/s12872-026-06359-7", "fulltext_url": "https://europepmc.org/articles/PMC13721431", "id": "fj2qknn3d0dvk", "issns": [ "1471-2261" ], "landing_url": "https://europepmc.org/article/MED/42963751", "language": "eng", "licence": "CC-BY", "licence_label": "CC BY", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "Study Protocol" ], [ "openalex", "2729|Pregnancy and preeclampsia studies" ] ], "openalex": "W7172405438", "pdf_url": "https://europepmc.org/articles/PMC13721431?pdf=render", "pmcid": "PMC13721431", "pmid": "42963751", "published": "2026-08-04", "publisher": "BMC", "ris": "https://research.draconitic.com/paper/fj2qknn3d0dvk.ris", "sources": [ { "first_seen": "2026-11-02T03:21:43Z", "native_id": "MED:42963751", "source": "europepmc", "url": "https://europepmc.org/article/MED/42963751" }, { "first_seen": "2026-11-03T12:22:07Z", "native_id": "PMC13721431", "source": "pmc", "url": "https://doi.org/10.1186/s12872-026-06359-7" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2729|Pregnancy and preeclampsia studies", "subfield": "reproductive-child" } ], "title": "Self-management of blood pressure following hypertensive pregnancy (the SNAP2 trial): a prospective, multi-centre, unblinded, randomised controlled trial protocol.", "title_text": "Self-management of blood pressure following hypertensive pregnancy (the SNAP2 trial): a prospective, multi-centre, unblinded, randomised controlled trial protocol.", "type": "peer-reviewed", "updated_at": "2026-11-03T12:22:07Z", "url": "https://research.draconitic.com/paper/fj2qknn3d0dvk", "venue": "BMC cardiovascular disorders", "versions": [] }