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Pregnancy, High RiskBUMPNCT03334149

Blood Pressure Monitoring in High Risk Pregnancy to Improve the Detection and Monitoring of Hypertension

A study testing Self-Monitoring of Blood Pressure in people with Pregnancy, High Risk and Pre-Eclampsia, run by University of Oxford at 13 sites in United Kingdom.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Raised blood pressure is a common problem in pregnancy. Raised blood pressure and pre-eclampsia affect about one in ten women and are a major cause of death and premature birth in the United Kingdom and worldwide. Read more about this study

Who is it for?
Ages 18 years and older, women onlyHealthy volunteers can take part
Conditions the study is for
Pregnancy, High Risk, Pre-Eclampsia, Hypertension
What is being tested?
Self-Monitoring of Blood Pressure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
3,042 participants
Where
13 sitesUnited Kingdom
Study dates
22 Nov 2017to 16 Sep 2020
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • Women only
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Participant is willing and able to give informed consent for participation in the trial
  • Pregnant woman, aged 18 years or above between 16+0 to 24+0 weeks
  • Able and willing to comply with trial requirements
  • Willing to allow her general practitioner and consultant, if appropriate, to be notified of participation in the trial
  • At higher risk for hypertension in pregnancy / pre-eclampsia defined as one or more of the following risk factors:
  • Age 40 years or older
Show all 26Show fewer
  • Nulliparity
  • Pregnancy interval of more than 10 years
  • Family history of pre-eclampsia
  • Previous history of pre-eclampsia or gestational hypertension
  • Body mass index 30 kg/m2 or above at booking
  • Chronic kidney disease
  • Twin pregnancy
  • Diabetes (Type 1\&2)
  • Autoimmune Disease (eg systemic lupus erythematosis or antiphospholipid disease)
  • Women developing pregnancy hypertension previously randomised in BUMP 1 (regardless of gestation).
  • OR
  • Women with chronic hypertension (defined as sustained systolic BP≥140 mmHg and/or diastolic BP≥90 mmHg, present at booking or before 20 weeks' gestation, or receiving treatment outside pregnancy and/or at time of referral).
  • Recruited up to 37+0 weeks' gestation.
  • OR
  • Women with hypertension after 20 weeks' gestation (defined as sustained systolic BP≥140 mmHg and/or diastolic BP≥90 mmHg).
  • Recruited at 20+0 to 37+0 weeks' gestation.
  • AND
  • Participant is willing and able to give informed consent for participation in the trial.
  • Woman aged 18 years or above.
  • Willing to allow her general practitioner and consultant, if appropriate, to be notified of participation in the trial.

Who cannot join

  • Chronic Hypertension
  • BUMP 2:
  • Anticipated inpatient admission considered likely to lead to imminent delivery (within the next 48 hours)

Trial locations and contacts

13 sites in 1 country.

13 sites in 1 country

United Kingdom13 sites
  • Buckinghamshire Healthcare NHS Trust

    Aylesbury, HP21 8AL

  • Birmingham Women's and Children's Hospital NHS Foundation Trust

    Birmingham, B15 2TG

  • Croydon Health Services NHS Trust

    London, CR7 7YE

  • Barts Health NHS Trust

    London, E1 1BB

  • Kingston Hospital NHS Foundation Trust

    London, KT2 7QB

  • Guy's and St Thomas' NHS Foundation Trust

    London, SE1 7EH

  • King's College Hospital NHS Foundation Trust

    London, SE5 9RS

  • Chelsea and Westminster Hospital NHS Foundation Trust

    London, SW10 9NH

  • St George's University Hospitals NHS Foundation Trust

    London, SW17 0QT

  • Manchester University NHS Foundation Trust

    Manchester, M13 9WL

  • Oxford University Hospitals NHS Foundation Trust

    Oxford, OX6 2GG

  • The Royal Berkshire NHS Foundation Trust

    Reading, RG1 5AN

  • The Royal Wolverhampton NHS Trust

    Wolverhampton, WV10 0QP

Other trials in United Kingdom

About this study

Raised blood pressure is a common problem in pregnancy. Raised blood pressure and pre-eclampsia affect about one in ten women and are a major cause of death and premature birth in the United Kingdom and worldwide.

Many women have expressed an interest in monitoring their own blood pressure in between antenatal visits but there has been very little research to guide this. The investigators would like to know if the diagnosis and subsequent care of women with raised blood pressure can be improved if women were able to monitor their own blood pressure safely at home. This work will test whether optimising the diagnosis, monitoring and management of raised BP during pregnancy through self-monitoring of BP is effective, acceptable and cost-effective compared to usual care.

Read more

The research team have being working with pregnant women, doctors and midwives to develop a simple and accurate method of self-monitoring of blood pressure in pregnancy.

This randomised controlled trial will:

  1. Compare self-monitoring with usual care in women at higher risk of hypertension in pregnancy and assess if self-monitoring can identify raised blood pressure earlier.
  2. Compare self-monitoring with usual care for women with high blood pressure in pregnancy to see if it leads to lower blood pressure.
  3. Assess if self-monitoring is cost-effective.

Pregnant women who chose to take part in these studies will be randomised to either usual care or asked to monitor their own blood pressure during their pregnancy in addition to their usual antenatal care.

Read the detailed description

BUMP 1 will randomise 2262 women at higher risk of hypertension in pregnancy into usual care or self-monitoring.

BUMP 2 will randomise 512 women with hypertension in pregnancy (including chronic hypertension) into usual care or self-monitoring. Women in BUMP 1 will move into BUMP 2 if they develop hypertension.

Women will be recruited at approximately 15 hospitals in England over approximately 24 months.

Women will be recruited from 20 weeks (BUMP 1) or early pregnancy(BUMP 2) and followed up until 2 months after birth.

Being tested
Self-Monitoring of Blood Pressure
Medical subject headings
Pre-Eclampsia, Hypertension, Hypertension, Pregnancy-Induced

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Self-Monitoring of Blood PressureOther

    BUMP 1: Women randomised to the self-monitoring arm will be asked to measure blood pressures at least three times a week. They will perform two readings with a one minute interval and will be asked to act on the second reading if it falls outside their normal range thresholds described in their instructions, and aided by the tele monitoring system.

    BUMP 2: Women randomised to the self-monitoring arm will be asked to measure blood pressures daily. They will perform two readings with a one minute interval and will be asked to act on the second reading if it falls outside their normal range thresholds described in their instructions, aided by a tele monitoring system.

Study groups in NCT03334149
Study groupRoleWhat they receive
Self-Monitoring of Blood PressureExperimentalBUMP 1: using a validated home blood pressure monitor at least 3 times a week to record blood pressure BUMP 2: using a validated home blood pressure monitor daily to record blood pressure Women in the intervention groups will be encouraged to use a simple mobile tele monitoring system.
Receives: Other: Self-Monitoring of Blood Pressure
Usual CareNo interventionWomen randomised to usual care will continue to have all their BP monitoring completed by the clinical team at their antenatal assessments.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Time from recruitment to diagnosis of raised blood pressure

    Difference between groups in time from recruitment to recording of raised blood pressure by health care professional.

    Measured: From study entry to delivery i.e. up to approximately 25 weeks from recruitment

  2. Mean systolic blood pressure

    Difference in mean systolic blood pressure between usual care and self-monitoring group.

    Measured: From study entry to delivery i.e. up to 40 weeks

Secondary outcomes (25)
  1. Severe hypertension

    Difference between usual care and self-monitoring group in severe hypertension (systolic BP ≥160mmHg and/or or diastolic BP ≥110mmHg) (BUMP 1 and BUMP 2)

    Measured: From study entry to delivery i.e. up to 40 weeks

  2. Serious maternal complications

    Difference between usual care and self-monitoring group in serious maternal complications (pre-eclampsia, placental abruption, transient ischemic attack or stroke, pulmonary oedema, renal failure, blood transfusion), death (BUMP 1 and BUMP 2)

    Measured: From study entry to delivery i.e. up to 40 weeks

  3. Onset of labour

    Difference between usual care and self-monitoring group in onset of labour (BUMP 1 and BUMP 2)

    Measured: At delivery

  4. Assessment of quality of life differences between arms

    Difference between usual care and self-monitoring group in change in quality of life (measured using the EQ-5D-5L) (BUMP 1 and BUMP 2)

    Measured: From study entry to 30 weeks of pregnancy, or from study entry to 2 weeks following study entry if randomised after 30 weeks pregnancy

  5. Assessment of quality of life differences between arms

    Difference between usual care and self-monitoring group in change in quality of life (measured using the EQ-5D-5L (BUMP 1 and BUMP 2)

    Measured: From study entry to 8 weeks postpartum i.e. up to 48 weeks

  6. Stillbirth

    Difference between usual care and self-monitoring group in number of stillbirths (BUMP 1 and BUMP 2)

    Measured: At delivery

  7. Early neonatal deaths

    Difference between usual care and self-monitoring group in number of early neonatal deaths (BUMP 1 BUMP 2)

    Measured: From delivery up to 28 days postpartum i.e. up to 4 weeks

  8. Gestation at delivery

    Difference between usual care and self-monitoring group in gestation at delivery (BUMP 1 and BUMP 2)

    Measured: At delivery

  9. Mode of delivery

    Difference between usual care and self-monitoring group in mode of delivery (BUMP 1 and BUMP 2)

    Measured: At delivery

  10. Birth weight including centile

    Difference between usual care and self-monitoring group in birth weight of the baby including centile (BUMP 1 and BUMP 2)

    Measured: At delivery

  11. Small for gestational age infants

    Difference between usual care and self-monitoring group in number of small for gestational age infants (<10th and <3rd centile) (BUMP 1 and BUMP 2)

    Measured: At delivery

  12. Neonatal unit admissions

    Difference between usual care and self-monitoring group in number of neonatal unit admissions including length of stay (BUMP 1 and BUMP 2)

    Measured: From delivery up to 28 days postpartum i.e. up to 4 weeks

  13. Health behaviours

    Difference between usual care and self-monitoring group in change in health behaviours (questionnaire) (BUMP 1 and BUMP 2)

    Measured: From study entry to 30 weeks of pregnancy, or from study entry to 2 weeks following study entry if randomised after 30 weeks pregnancy.

  14. Health behaviours

    Difference between usual care and self-monitoring group in change in health behaviours (questionnaire) (BUMP 1 and BUMP 2)

    Measured: From study entry to 8 weeks postnatal i.e. up to 48 weeks

  15. Fidelity to monitoring schedule

    Difference between usual care and self-monitoring group in fidelity to monitoring schedule (BUMP 1 and BUMP 2)

    Measured: From study entry to delivery i.e. up to 48 weeks

  16. STAI-6 short form anxiety questionnaire

    Difference between usual care and self-monitoring group in change in State trait anxiety inventory short form anxiety questionnaire (STAI-6 ) (BUMP 1 and BUMP 2)

    Measured: From study entry to 30 weeks of pregnancy, or from study entry to 2 weeks following study entry if randomised after 30 weeks pregnancy.

  17. STAI-6 short form anxiety questionnaire

    Difference between usual care and self-monitoring group in change in STAI-6 short form anxiety questionnaire (BUMP 1 and BUMP 2)

    Measured: From study entry to 8 weeks postnatal i.e. up to 48 weeks

  18. Health service costs

    Difference between usual care and self-monitoring group in health service costs. (BUMP 1 and BUMP 2)

    Measured: From study entry to delivery i.e. up to 40 weeks

  19. Cost per quality-adjusted life year gained over trial period

    Difference between usual care and self-monitoring group in cost per quality-adjusted life year gained over trial period (BUMP 1 and BUMP 2)

    Measured: From study entry to delivery i.e. up to 40 weeks

  20. Qualitative

    Qualitative data gathered from participating women and healthcare professionals (BUMP 1 and BUMP 2)

    Measured: From study entry to 8 weeks postpartum i.e. up to 48 weeks

  21. Mean diastolic blood pressure

    Difference between usual care and self-monitoring group in mean diastolic blood pressure (BUMP 2)

    Measured: From study entry to delivery i.e. up to 40 weeks

  22. Mean area under the blood pressure over time curve

    Difference between usual care and self-monitoring group in mean area under the blood pressure curve (BUMP 2)

    Measured: From study entry to delivery i.e. up to 40 weeks

  23. Mean proportion of readings above 140mmHg

    Difference between usual care and self-monitoring group in mean proportion of readings above 140mmHg (BUMP 2)

    Measured: From study entry to delivery i.e. up to 40 weeks

  24. Adherence to medication

    Difference between usual care and self-monitoring group in change in adherence to medication (MARS) (BUMP 2)

    Measured: From study entry to 30 weeks of pregnancy, or from study entry to 2 weeks following study entry if randomised after 30 weeks pregnancy.

  25. Adherence to medication

    Difference between usual care and self-monitoring group in change in adherence to medication (MARS) (BUMP 2)

    Measured: From study entry to 8 weeks postnatal i.e. up to 48 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted7 Nov 2017
  2. Study start22 Nov 2017
  3. Primary completion16 Sep 2020
  4. Study completion16 Sep 2020

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Health services research
Allocation
Randomised
Intervention model
Parallel groups
Model description
Note Women in BUMP 1 will transfer to BUMP 2 if they develop hypertension. Women in BUMP 2 can be randomised de novo or join from BUMP 1 maintaining their original randomisation. The enrolment number below therefore includes BUMP 1 (2262) plus BUMP 2 (512). Permission was granted by the ethics committee to continue recruitment passed the original sample size until the original planned end of recruitment date.
Masking
None (open label)
Enrolment
3,042 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03334149
Sponsor's protocol ID
224978
Acronym
BUMP
Status last verified
Jan 2022
First submitted
24 Oct 2017
Last updated
6 Jun 2022
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Data are available from the authors upon reasonable request and with permission of the University of Oxford. Use of data will require approval by an independent review committee identified for this purpose and investigators requesting data will need to provide a written protocol including analysis plan and sign a data sharing/access agreement. Requests for Data Sharing should be directed to information.guardian@phc.ox.ac.uk.

Publications

  • Dougall G, Franssen M, Tucker KL, Yu LM, Hinton L, Rivero-Arias O, Abel L, Allen J, Band RJ, Chisholm A, Crawford C, Green M, Greenfield S, Hodgkinson J, Leeson P, McCourt C, MacKillop L, Nickless A, Sandall J, Santos M, Tarassenko L, Velardo C, Wilson H, Yardley L, Chappell L, McManus RJ. Blood pressure monitoring in high-risk pregnancy to improve the detection and monitoring of hypertension (the BUMP 1 and 2 trials): protocol for two linked randomised controlled trials. BMJ Open. 2020 Jan 23;10(1):e034593. doi: 10.1136/bmjopen-2019-034593.

    PubMed 31980512
  • Tucker KL, Mort S, Yu LM, Campbell H, Rivero-Arias O, Wilson HM, Allen J, Band R, Chisholm A, Crawford C, Dougall G, Engonidou L, Franssen M, Green M, Greenfield S, Hinton L, Hodgkinson J, Lavallee L, Leeson P, McCourt C, Mackillop L, Sandall J, Santos M, Tarassenko L, Velardo C, Yardley L, Chappell LC, McManus RJ; BUMP Investigators. Effect of Self-monitoring of Blood Pressure on Diagnosis of Hypertension During Higher-Risk Pregnancy: The BUMP 1 Randomized Clinical Trial. JAMA. 2022 May 3;327(17):1656-1665. doi: 10.1001/jama.2022.4712.

    PubMed 35503346
  • Chappell LC, Tucker KL, Galal U, Yu LM, Campbell H, Rivero-Arias O, Allen J, Band R, Chisholm A, Crawford C, Dougall G, Engonidou L, Franssen M, Green M, Greenfield S, Hinton L, Hodgkinson J, Lavallee L, Leeson P, McCourt C, Mackillop L, Sandall J, Santos M, Tarassenko L, Velardo C, Wilson H, Yardley L, McManus RJ; BUMP 2 Investigators. Effect of Self-monitoring of Blood Pressure on Blood Pressure Control in Pregnant Individuals With Chronic or Gestational Hypertension: The BUMP 2 Randomized Clinical Trial. JAMA. 2022 May 3;327(17):1666-1678. doi: 10.1001/jama.2022.4726.

    PubMed 35503345
  • Campbell HE, Chappell LC, McManus RJ, Tucker KL, Crawford C, Green M, Rivero-Arias O. Detection and Control of Pregnancy Hypertension Using Self-Monitoring of Blood Pressure With Automated Telemonitoring: Cost Analyses of the BUMP Randomized Trials. Hypertension. 2024 Apr;81(4):887-896. doi: 10.1161/HYPERTENSIONAHA.123.22059. Epub 2024 Jan 23.

    PubMed 38258566
  • Hinton L, Hodgkinson J, Tucker KL, Rozmovits L, Chappell L, Greenfield S, McCourt C, Sandall J, McManus RJ. Exploring the potential for introducing home monitoring of blood pressure during pregnancy into maternity care: current views and experiences of staff-a qualitative study. BMJ Open. 2020 Dec 1;10(12):e037874. doi: 10.1136/bmjopen-2020-037874.

    PubMed 33262186
  • Ashworth DC, Maule SP, Stewart F, Nathan HL, Shennan AH, Chappell LC. Setting and techniques for monitoring blood pressure during pregnancy. Cochrane Database Syst Rev. 2020 Jul 23;8(8):CD012739. doi: 10.1002/14651858.CD012739.pub2.

    PubMed 32748394

Questions about this trial

What is this clinical trial studying?

A study testing Self-Monitoring of Blood Pressure in people with Pregnancy, High Risk and Pre-Eclampsia, run by University of Oxford at 13 sites in United Kingdom.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 26 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 6 Jun 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 13 sites in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Time from recruitment to diagnosis of raised blood pressure (time frame: From study entry to delivery i.e. up to approximately 25 weeks from recruitment). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03334149, which also lists 6 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 Jun 2022.

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