The BMJ Today: Safe self monitoring and patient treatments

Hypertensive disorders in pregnancy are a leading cause of maternal mortality worldwide, with associated problems of poor foetal growth, low birth weight, and preterm delivery. While there is a trend towards pregnant women monitoring their own blood pressure, a recent analysis article asks if this is safe and effective? Guidelines encourage it and research suggests that women prefer it, however, Hodgkinson and colleagues advise caution.

They list some of the disadvantages of self monitoring, including the lack of validation of some monitors, as well as no diagnostic thresholds from home monitoring to identify pre-eclampsia or gestational hypertension. The authors call for a strengthening of the evidence base before this is recommended as a formally accepted part of antenatal care.

They do stress that if patients choose to self monitor, then it is important to acknowledge this and respect their choices, encouraging them to share their results while offering help to interpret them.

Paul Wicks, posting in a recent rapid response, thinks that there is increasing pressure being put on patients to self manage, “albeit with a dearth of robust tools to help them do this—setting many patients up for failure.” He describes the challenges of patients grappling with newer and more complex therapies other than just the “little white pill,” and discusses validation of a treatment burden questionnaire.

And finally, while for some it may seem like a strange time of year to be discussing the use of grass pollen immunotherapy in treating patients with allergic rhinitis, an education article by Slovick and colleagues discuss how well this works, with some useful tips for patients. A three year course of treatment is started several months before grass pollen season, and so now is the perfect time to consider specialist referral to avoid problems next summer—and for several years after—they say.

Cath Brizzell is head of education, The BMJ.