Main findings
We demonstrate feasibility and high retention in a randomized trial of postpartum home blood pressure monitoring plus a lifestyle intervention among a diverse sample of overweight and obese individuals with HDP. Importantly, while our study is not powered to show a statistical difference in efficacy, we note that home blood pressure monitoring and home blood pressure monitoring plus our lifestyle intervention arms had lower mean arterial blood pressure compared to controls at one-year postpartum and we detected statistically significant decreases in sodium consumption associated with the full intervention. We also demonstrate a high proportion of participants with ongoing hypertension at one-year postpartum, with over half meeting criteria for stage 1 hypertension, over 20% with stage 2 hypertension and 10% of participants still requiring anti-hypertensive agents. We showed no statistical difference in weight change across study arms, suggesting that any changes in blood pressure were not secondary to weight loss in the intervention arms. Particularly relevant in this population of overweight and obese participants is the significant weight retention at one-year postpartum, with less than 30% of individuals returning to their pre-pregnancy weight by study completion.