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SNAP-2

Optimising the management of blood pressure following hypertensive pregnancy to reduce cardiovascular risk

Background and trial aims

Raised blood pressure (hypertension) is common in pregnancy, affecting approximately 1 in 10 women. Blood pressure remains elevated after birth, but usually returns to normal over 2 to 12 weeks. 

This trial is testing whether women who have experienced a hypertensive pregnancy can achieve better blood pressure control in the weeks and months following the end of pregnancy by using an app to enter their self-administered blood pressure readings (which are reviewed by a medical team) and adjust their antihypertensive medication accordingly. It aims to improve long-term blood pressure control and therefore reduce adverse cardiovascular outcomes and the associated costs to the NHS.

We are also carrying out an optional sub-study to investigate the role of self-management of raised blood pressure after birth.

Interested in finding out more about SNAP-2?

If you are curious about taking part, or are a researcher or healthcare professional, you can find more resources and information about the study by clicking the relevant panel below.

Logo featuring woman wearing blood pressure monitor carrying a baby.

Trial status: Recruiting

Study period: January 2024 – July 2026

Contact details:

Email: snap2trial@phc.ox.ac.uk

Phone: 0808 252 4539

What does the study involve?

Potential participants will be approached for recruitment into the study when admitted to participating hospital antenatally.

After reading about the study and speaking with a healthcare professional, you will be asked to sign a consent form to confirm that you agree to take part. We will ask you some brief questions about your medical history, your pregnancy, and day-to-day life.

You will then be randomly assigned by a computer to either the self-management group, or the control group who will receive usual care.

Self-management group

If placed in the self-management group, we will give you a blood pressure monitor to keep and tell you how to access the “My Blood Pressure Care” app. You will be asked to take your own blood pressure readings after giving birth. This will involve taking 2 readings, 1 minute apart, every day for the first few weeks. If the readings are raised, you may be asked for more readings.

An obstetrician or your GP will look over your blood pressure readings from the app and make any necessary changes to any blood pressure medication, and will confirm these changes by text. Please note that prescribed blood pressure medications are safe for breast feeding.

Usual care group

If placed in the usual care group, you will have your blood pressure monitored by your community midwife and GP after you have given birth. You will carry on receiving your usual care as you did before the study from your midwife, consultant, or healthcare professional. Participation in the usual care group is very important to establishing the validity of our research.

Follow-up

All participants in both groups will continue to receive routine NHS care and will be asked to speak with the research team 6 weeks, 12 weeks, 6 months, and 1 year after giving birth to record your blood pressure and go through a short questionnaire.

For more information on the trial and its objectives, please follow the 'For participating women' link above.

Who can participate?

We are seeking women at participating sites in England who are:

  • 18 and over.
  • Yet to give birth, or who have given birth in the last 7 days.
  • Have had raised blood pressure throughout their pregnancy (chronic hypertension, gestational hypertension, or pre-eclampsia).
  • Require drug treatment after giving birth.

Optional sub-study

We would like to interview women who have taken part in the SNAP2 trial following their pregnancy, as well as women who decided not to take part in the study.

We want to understand how people feel about monitoring their blood pressure themselves at home after giving birth. We will also talk to a group of people who are not doing this self-management to see how their experiences compare.

Even if someone doesn't want to be part of the main study or drops out later, we will still invite them to an interview to learn more about why they declined and what they think about the self-management approach.

We will work with midwives to interview people from diverse groups. Please be aware that not everyone who expresses an interest to take part in this sub-study will be invited for an interview.

Those participants taking part in this qualitative study will receive a £20 voucher for their time.

Trial Team

Oxford Co-Investigators

External Co-Investigators

Professor Lucy Yardley (University of Bristol)

Professor Debra Bick (University of Warwick)

Professor Jenny Myers (University of Manchester)

Professor Lucy Chappell (King’s College London)

Professor Christine McCourt (City, University of London)

Dr Lucy Mackillop (Oxford University Hospitals Foundation Trust)

Marcus Green (Action on Pre-eclampsia Limited)

Sandra Igwe (The Motherhood Group Limited)

Funded by the NIHR

Funding Details

SNAP-2 is funded by the National Institute for Health and Care Research (NIHR) Collaboration for Leadership in Applied Health Research and Care Oxford

REC: 24/SC/0071

IRAS: 332333

Registration: ISRCTN11042045

Publications and resources

For copies of all study documentation click here.