Self-management of blood pressure following hypertensive pregnancy (the SNAP2 trial): a prospective, multi-centre, unblinded, randomised controlled trial protocol.
18 affiliations
- 1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom. [email protected].
- 2Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
- 3Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
- 4Maternal and Fetal Health Research Centre, University of Manchester, Manchester, United Kingdom.
- 5Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
- 6National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
- 7Department of Women and Children's Health, Kings College London, London, United Kingdom.
- 8Action on Pre-eclampsia charity, Worcestershire, United Kingdom.
- 9Department of Cardiovascular Sciences, Leicester British Heart Foundation Centre of Research Excellence, University of Leicester, Leicester, United Kingdom.
- 10The Motherhood Group, London, United Kingdom.
- 11Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom.
- 12Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom.
- 13School of Health and Medical Sciences, City St George's, University of London, London, United Kingdom.
- 14School of Psychological Science, University of Bristol, Bristol, United Kingdom.
- 15Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom.
- 16NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom.
- 17School of Psychology, University of Southampton, Southampton, United Kingdom.
- 18University of Brighton and University of Sussex, Brighton and Sussex Medical School, Brighton, United Kingdom.
Abstract
Background
Hypertensive 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
SNAP2 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
The 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 .
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BibTeX
@article{goddard2026selfmanagement,
title = {{Self-management of blood pressure following hypertensive pregnancy (the SNAP2 trial): a prospective, multi-centre, unblinded, randomised controlled trial protocol.}},
author = {Lucy Goddard and Ellie Newbury and Katherine Tucker and Natalie Barry and Debra Bick and Helen Campbell and Lucy C Chappell and Paphapisa Chotthanawathit and Kate Corfield and Marcus Green and Pankaj Gupta and Lisa Hinton and Sandra Ignew and Nicola Kenealy and Paul Leeson and Rosa Mackay and Lucy Mackillop and Christine McCourt and Kate Moon and Jenny Myers and Cynthia Ochieng and Hannah Rayment-Jones and Oliver Rivero-Arias and Cristian Roman and Milensu Shanyinde and Mayue Shi and Lionel Tarassenko and Lucy Yardley and Ly-Mee Yu and Richard J McManus},
journal = {BMC cardiovascular disorders},
year = {2026},
month = aug,
doi = {10.1186/s12872-026-06359-7},
url = {https://europepmc.org/article/MED/42963751},
note = {CC BY},
}
RIS
TY - JOUR
TI - Self-management of blood pressure following hypertensive pregnancy (the SNAP2 trial): a prospective, multi-centre, unblinded, randomised controlled trial protocol.
AU - Lucy Goddard
AU - Ellie Newbury
AU - Katherine Tucker
AU - Natalie Barry
AU - Debra Bick
AU - Helen Campbell
AU - Lucy C Chappell
AU - Paphapisa Chotthanawathit
AU - Kate Corfield
AU - Marcus Green
AU - Pankaj Gupta
AU - Lisa Hinton
AU - Sandra Ignew
AU - Nicola Kenealy
AU - Paul Leeson
AU - Rosa Mackay
AU - Lucy Mackillop
AU - Christine McCourt
AU - Kate Moon
AU - Jenny Myers
AU - Cynthia Ochieng
AU - Hannah Rayment-Jones
AU - Oliver Rivero-Arias
AU - Cristian Roman
AU - Milensu Shanyinde
AU - Mayue Shi
AU - Lionel Tarassenko
AU - Lucy Yardley
AU - Ly-Mee Yu
AU - Richard J McManus
PY - 2026
DA - 2026/08/04
JO - BMC cardiovascular disorders
DO - 10.1186/s12872-026-06359-7
UR - https://europepmc.org/article/MED/42963751
AB - Background Hypertensive 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 SNAP2 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 The 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 .
SN - 1471-2261
ER -