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Importance Inadequate management of elevated blood pressure is a significant contributing factor to maternal deaths. The role of blood pressure self-monitoring in pregnancy in improving clinical outcomes for the pregnant individual and infant is unclear. Objective To evaluate the effect of blood pressure self-monitoring, compared with usual care alone, on blood pressure control and other related maternal and infant outcomes, in individuals with pregnancy hypertension. Design, Setting, and Participants Unblinded, randomized clinical trial that recruited between November 2018 and September 2019 in 15 hospital maternity units in England. Individuals with chronic hypertension (enrolled up to 37 weeks’ gestation) or with gestational hypertension (enrolled between 20 and 37 weeks’ gestation). Final follow-up was in May 2020. Interventions Participants were randomized to either blood pressure self-monitoring using a validated monitor and a secure telemonitoring system in addition to usual care (n = 430) or to usual care alone (n = 420). Usual care comprised blood pressure measured by health care professionals at regular antenatal clinics. Main Outcomes and Measures The primary maternal outcome was the difference in mean systolic blood pressure recorded by health care professionals between randomization and birth. Results Among 454 participants with chronic hypertension (mean age, 36 years; mean gestation at entry, 20 weeks) and 396 with gestational hypertension (mean age, 34 years; mean gestation at entry, 33 weeks) who were randomized, primary outcome data were available from 444 (97.8%) and 377 (95.2%), respectively. In the chronic hypertension cohort, there was no statistically significant difference in mean systolic blood pressure for the self-monitoring groups vs the usual care group (133.8 mm Hg vs 133.6 mm Hg, respectively; adjusted mean difference, 0.03 mm Hg [95% CI, −1.73 to 1.79]). In the gestational hypertension cohort, there was also no significant difference in mean systolic blood pressure (137.6 mm Hg compared with 137.2 mm Hg; adjusted mean difference, −0.03 mm Hg [95% CI, −2.29 to 2.24]). There were 8 serious adverse events in the self-monitoring group (4 in each cohort) and 3 in the usual care group (2 in the chronic hypertension cohort and 1 in the gestational hypertension cohort). Conclusions and Relevance Among pregnant individuals with chronic or gestational hypertension, blood pressure self-monitoring with telemonitoring, compared with usual care, did not lead to significantly improved clinic-based blood pressure control. Trial Registration ClinicalTrials.gov Identifier: NCT03334149

In December 1999, the so-called “Vargas Tragedy” destroyed the Venezuelan coast after days of torrential rain caused over fifty landslides in the greater metropolitan area of Caracas. The disaster coincided with a referendum to redraft the Venezuelan constitution during the first year of Bolivarian Socialism, and was conceived of as a punctual political event that marked the beginning of a new historical period for Venezuela. This understanding of the landslides has been contested by authors and filmmakers who negotiate ecological crises as complex multitemporal, transnational processes. Focusing on the use of child protagonists in Una tarde con campanas (2004), a novel by Juan Carlos Méndez Guédez, and El chico que miente (2011), a film directed by Marité Ugás, this article analyses the creative strategies employed in contemporary Venezuelan culture that foreground alternative responses to the landslides. On the one hand, I argue that adolescence is used in these texts as a figurative device that rebels against the politicisation of the disaster and thus, by extension, undermines the state’s elision of a post-catastrophic and post-capitalist future. On the other, I argue that childhood is mediated as a heterogeneous site that defies facile reification, much like the disaster, and invites a reconsideration of the ways in which we conceptualise the relationship between the human and the non-human., En diciembre de 1999, la llamada “tragedia de Vargas” destruyó la costa venezolana después de días de lluvias torrenciales que causaron más de cincuenta derrumbes en las afueras de Caracas. El desastre coincidió con un referéndum para reformar la constitución venezolana durante el primer año del mandato de Hugo Chávez y, por lo tanto, se consideró un evento histórico que rompió con la “cuarta república” y marcó una nueva era para el país bolivariano. En el ámbito cultural, esta visión del desastre ha sido rechazada por varios autores y directores venezolanos, quienes señalan al desastre como un proceso no cronológico cuyos efectos e impactos transcienden las fronteras nacionales. Este artículo analiza el trama pos-catastrófico protagonizado por niños en Una tarde con campanas (2004), una novela de Juan Carlos Méndez Guédez, y El chico que miente (2011), una película de Marité Ugás. Por un lado, argumento que estos textos recurren a la infancia como un mecanismo narrativo que confronta la politización de la supervivencia y, por extensión, desautoriza las visiones de un futuro pos-capitalista/pos-catastrófico. Por otro lado, sugiero que la infancia se ve como un sitio heterogéneo que niega la codificación y el dualismo sociedad/naturaleza, exigiendo así una reconsideración de las relaciones entre lo humano y lo no-humano.

In December 1999, the so-called “Vargas Tragedy” destroyed the Venezuelan coast after days of torrential rain caused over fifty landslides in the greater metropolitan area of Caracas. The disaster coincided with a referendum to redraft the Venezuelan constitution during the first year of Bolivarian Socialism, and was conceived of as a punctual political event that marked the beginning of a new historical period for Venezuela. This understanding of the landslides has been contested by authors and filmmakers who negotiate ecological crises as complex multitemporal, transnational processes. Focusing on the use of child protagonists in Una tarde con campanas (2004), a novel by Juan Carlos Méndez Guédez, and El chico que miente (2011), a film directed by Marité Ugás, this article analyses the creative strategies employed in contemporary Venezuelan culture that foreground alternative responses to the landslides. On the one hand, I argue that adolescence is used in these texts as a figurative device that rebels against the politicisation of the disaster and thus, by extension, undermines the state’s elision of a post-catastrophic and post-capitalist future. On the other, I argue that childhood is mediated as a heterogeneous site that defies facile reification, much like the disaster, and invites a reconsideration of the ways in which we conceptualise the relationship between the human and the non-human. En diciembre de 1999, la llamada “tragedia de Vargas” destruyó la costa venezolana después de días de lluvias torrenciales que causaron más de cincuenta derrumbes en las afueras de Caracas. El desastre coincidió con un referéndum para reformar la constitución venezolana durante el primer año del mandato de Hugo Chávez y, por lo tanto, se consideró un evento histórico que rompió con la “cuarta república” y marcó una nueva era para el país bolivariano. En el ámbito cultural, esta visión del desastre ha sido rechazada por varios autores y directores venezolanos, quienes señalan al desastre como un proceso no cronológico cuyos efectos e impactos transcienden las fronteras nacionales. Este artículo analiza el trama pos-catastrófico protagonizado por niños en Una tarde con campanas (2004), una novela de Juan Carlos Méndez Guédez, y El chico que miente (2011), una película de Marité Ugás. Por un lado, argumento que estos textos recurren a la infancia como un mecanismo narrativo que confronta la politización de la supervivencia y, por extensión, desautoriza las visiones de un futuro pos-capitalista/pos-catastrófico. Por otro lado, sugiero que la infancia se ve como un sitio heterogéneo que niega la codificación y el dualismo sociedad/naturaleza, exigiendo así una reconsideración de las relaciones entre lo humano y lo no-humano.