Relationships Between Blood Pressure Reduction, Weight Loss, and Engagement in a Digital App–Based Hypertension Care Program: Observational Study

Abstract

Background Home blood pressure (BP) monitoring is recommended for people with hypertension; however, meta-analyses have demonstrated that BP improvements are related to additional coaching support in combination with self-monitoring, with little or no effect of self-monitoring alone. High-contact coaching requires substantial resources and may be difficult to deliver via human coaching models. Objective This observational study assessed changes in BP and body weight following participation in a fully digital program called Lark Hypertension Care with coaching powered by artificial intelligence (AI). Methods Participants (N=864) had a baseline systolic BP (SBP) ≥120 mm Hg, provided their baseline body weight, and had reached at least their third month in the program. The primary outcome was the change in SBP at 3 and 6 months, with secondary outcomes of change in body weight and associations of changes in SBP and body weight with participant demographics, characteristics, and program engagement. Results By month 3, there was a significant drop of –5.4 mm Hg (95% CI –6.5 to –4.3; P<.001) in mean SBP from baseline. BP did not change significantly (ie, the SBP drop maintained) from 3 to 6 months for participants who provided readings at both time points (P=.49). Half of the participants achieved a clinically meaningful drop of ≥5 mm Hg by month 3 (178/349, 51.0%) and month 6 (98/199, 49.2%). The magnitude of the drop depended on starting SBP. Participants classified as hypertension stage 2 had the largest mean drop in SBP of –12.4 mm Hg (SE 1.2 mm Hg) by month 3 and –13.0 mm Hg (SE 1.6 mm Hg) by month 6; participants classified as hypertension stage 1 lowered by –5.2 mm Hg (SE 0.8) mm Hg by month 3 and –7.3 mm Hg (SE 1.3 mm Hg) by month 6; participants classified as elevated lowered by –1.1 mm Hg (SE 0.7 mm Hg) by month 3 but did not drop by month 6. Starting SBP (β=.11; P<.001), percent weight change (β=–.36; P=.02), and initial BMI (β=–.56; P<.001) were significantly associated with the likelihood of lowering SBP ≥5 mm Hg by month 3. Percent weight change acted as a mediator of the relationship between program engagement and drop in SBP. The bootstrapped unstandardized indirect effect was –0.0024 (95% CI –0.0052 to 0; P=.002). Conclusions A hypertension care program with coaching powered by AI was associated with a clinically meaningful reduction in SBP following 3 and 6 months of program participation. Percent weight change was significantly associated with the likelihood of achieving a ≥5 mm Hg drop in SBP. An AI-powered solution may offer a scalable approach to helping individuals with hypertension achieve clinically meaningful reductions in their BP and associated risk of cardiovascular disease and other serious adverse outcomes via healthy lifestyle changes such as weight loss.

Exploring the Role of Wearable Electronic Medical Devices in Improving Cardiovascular Risk Factors and Outcomes Among Adults: A Systematic Review

“…There was one case report and five randomized controlled trials. Most studies used wearable devices as the focus of their investigations [1,[13][14][15][16], while others used these devices as part of a broader investigation [17][18][19]. We identified a total of 15 systematic reviews using the search criteria outlined above.…”

“…Other interventions must be introduced to augment the role of these instruments or realize their full potential [13][14][15]. There is no doubt that added supervision of patients is associated with better cardiovascular outcomes rather than selfmonitoring alone [16]. Therefore, in instances of professional mentorship toward better cardiac health, while monitoring devices are helpful, they may not necessarily be central and cannot be regarded as a gamechanger [16].…”

“…Increased physical activity is likely the most profound benefit of wearable devices [3,[13][14][15][16]18,22,25,27]. Physical activity is a modifiable risk factor [8].…”

“…There was one case report and five randomized controlled trials. Most studies used wearable devices as the focus of their investigations [ 1 , 13 - 16 ], while others used these devices as part of a broader investigation [ 17 - 19 ]. Table 4 summarizes the study articles by type, quality assessment used, number of patients, study focus, and year of publication.…”

The Effects of Providing a Connected Scale in an App-Based Digital Health Program: Cross-sectional Examination

“…We conducted an observational study of members enrolled in an artificial intelligence (AI)–powered digital health program available via smartphone on a platform called Lark. Information about Lark is published elsewhere [ 5 , 6 ]. We examined differences in self-weighing and retention between members with and without scales provided by their commercial insurance provider.…”