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Efficacy of a mobile hypertension prevention delivery platform with human coaching


This pilot study evaluated the efficacy of a Hypertension Prevention Program (HPP) administered through a mobile application platform with human coaching (app) on reduction in blood pressure and weight in 50 adults with prehypertension or hypertension. Participants were recruited into a 24-week mobile application intervention to administer the HPP between January 2016 and July 2016. Dietary elements of the programme were based on the Dietary Approaches to Stop Hypertension. The programme included in-app human coaching with bi-weekly phone calls, meal logging, blood pressure tracking and educational material. Main outcome variables included change in systolic and diastolic blood pressure, hypertension category, and weight loss. Data were analysed between October 2016 and December 2016. The HPP yielded overall improvements in weight (−3.04±4.04 kg, P=<0.001), diastolic blood pressure (−5.06±11.89 mm Hg, P=0.004), and hypertension category (−0.48±0.74 mm Hg, P=<0.001). Sustained engagement of 80% resulted in significant reductions in systolic blood pressure (−7.75±12.56, P=<0.001) and weight (−3.73±4.01 kg, P<0.001) for programme completers, contributing to hypertension category change (−0.58±0.64 mm Hg, P<0.001). Mobile delivery of a lifestyle intervention for hypertension prevention showed short-term potential to reduce risk of hypertension, supporting the need for longer studies to investigate the use of mHealth lifestyle modification to reduce the risk of hypertension, a public health priority.

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  1. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J et al. Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014; 311 (5): 507–520.

    Article  CAS  PubMed  Google Scholar 

  2. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289 (19): 2560–2572.

    Article  CAS  PubMed  Google Scholar 

  3. Huang Y, Wang S, Cai X, Mai W, Hu Y, Tang H et al. Prehypertension and incidence of cardiovascular disease: a meta-analysis. BMC Med 2013; 11: 177.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Li Y, Xia P, Xu L, Wang Y, Chen L . A meta-analysis on prehypertension and chronic kidney disease. PLoS ONE 2016; 11 (6): e0156575.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Gupta AK, McGlone M, Greenway FL, Johnson WD . Prehypertension in disease-free adults: a marker for an adverse cardiometabolic risk profile. Hypertens res 2010; 33 (9): 905–910.

    Article  PubMed  Google Scholar 

  6. Muntner P, Woodward M, Mann DM, Shimbo D, Michos ED, Blumenthal RS et al. Comparison of the Framingham Heart Study hypertension model with blood pressure alone in the prediction of risk of hypertension: the Multi-Ethnic Study of Atherosclerosis. Hypertension 2010; 55 (6): 1339–1345.

    Article  CAS  PubMed  Google Scholar 

  7. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M et al. Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation 2015; 131 (4): e29–e322.

    PubMed  Google Scholar 

  8. Whelton PK, Appel L, Charleston J, Dalcin AT, Ewart C, Fried L et al. The effects of nonpharmacologic interventions on blood pressure of persons with high normal levels. Results of the Trials of Hypertension Prevention, Phase I. JAMA 1992; 267 (9): 1213–1220.

    Article  Google Scholar 

  9. Stevens VJ, Corrigan SA, Obarzanek E, Bernauer E, Cook NR, Hebert P et al. Weight loss intervention in phase 1 of the Trials of Hypertension Prevention. The TOHP Collaborative Research Group. Arch int med 1993; 153 (7): 849–858.

    Article  CAS  Google Scholar 

  10. Whelton PK, Appel L, Charleston J, Dalcin AT, Ewart C, Fried L et al. Effects of weight loss and sodium reduction intervention on blood pressure and hypertension incidence in overweight people with high-normal blood pressure. The Trials of Hypertension Prevention, phase II. The Trials of Hypertension Prevention Collaborative Research Group. Arch int med 1997; 157 (6): 657–667.

    Article  Google Scholar 

  11. Look ARG, Wing RR . Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch int med 2010; 170 (17): 1566–1575.

    Google Scholar 

  12. Pi-Sunyer X . The Look AHEAD Trial: a review and discussion of its outcomes. Curr Nutr Rep 2014; 3 (4): 387–391.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Whelton PK, He J, Appel LJ, Cutler JA, Havas S, Kotchen TA et al. Primary prevention of hypertension: clinical and public health advisory from The National High Blood Pressure Education Program. JAMA 2002; 288 (15): 1882–1888.

    Article  PubMed  Google Scholar 

  14. Stamler R . Implications of the INTERSALT study. Hypertension 1991; 17 (1 Suppl): I16–I20.

    Article  CAS  PubMed  Google Scholar 

  15. Your Guide to Lowering Your Blood Pressure With DASH. NIH Pub No 06-4082. Bethesda, MD: U.S. Department of Health and Human Services; National Heart, Lung, and Blood Institute; 2006.

  16. Hageman PA, Pullen CH, Hertzog M, Boeckner LS . Effectiveness of tailored lifestyle interventions, using web-based and print-mail, for reducing blood pressure among rural women with prehypertension: main results of the Wellness for Women: DASHing towards Health clinical trial. Int J Behav Nutr Phys Act 2014; 11: 148.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Michaelides A, Raby C, Wood M, Farr K, Toro-Ramos T . Weight loss efficacy of a novel mobile Diabetes Prevention Program delivery platform with human coaching. BMJ Open Diabetes Res Care 2016; 4 (1): e000264.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Sepah SC, Jiang L, Peters AL . Long-term outcomes of a Web-based diabetes prevention program: 2-year results of a single-arm longitudinal study. J med Internet res 2015; 17 (4): e92.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346 (6): 393–403.

    Article  CAS  PubMed  Google Scholar 

  20. Marquez Contreras E, de la Figuera von Wichmann M, Gil Guillen V, Ylla-Catala A, Figueras M, Balana M et al. [Effectiveness of an intervention to provide information to patients with hypertension as short text messages and reminders sent to their mobile phone (HTA-Alert)]. Aten Primaria 2004; 34 (8): 399–405.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Friedman RH, Kazis LE, Jette A, Smith MB, Stollerman J, Torgerson J et al. A telecommunications system for monitoring and counseling patients with hypertension. Impact on medication adherence and blood pressure control. Am j hypertens 1996; 9 (4 Pt 1): 285–292.

    Article  CAS  PubMed  Google Scholar 

  22. Rubinstein A, Miranda JJ, Beratarrechea A, Diez-Canseco F, Kanter R, Gutierrez L et al. Effectiveness of an mHealth intervention to improve the cardiometabolic profile of people with prehypertension in low-resource urban settings in Latin America: a randomised controlled trial. Lancet Diabetes Endocrinol 2016; 4 (1): 52–63.

    Article  PubMed  Google Scholar 

  23. Sepah SC, Jiang L, Peters AL . Translating the Diabetes Prevention Program into an online social network: validation against CDC standards. Diabetes Educ 2014; 40 (4): 435–443.

    Article  PubMed  Google Scholar 

  24. CDC. Centers for Disease Control and Prevention Diabetes Prevention Recognition Program: standards and operating procedures 2015.

  25. Moore TJ, Alsabeeh N, Apovian CM, Murphy MC, Coffman GA, Cullum-Dugan D et al. Weight, blood pressure, and dietary benefits after 12 months of a web-based Nutrition Education Program (DASH for health): longitudinal observational study. J med Internet res 2008; 10 (4): e52.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Watson AJ, Singh K, Myint UK, Grant RW, Jethwani K, Murachver E et al. Evaluating a web-based self-management program for employees with hypertension and prehypertension: a randomized clinical trial. Am heart j 2012; 164 (4): 625–631.

    Article  PubMed  Google Scholar 

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We would like to express our gratitude to all the participants in this study. This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. We also thank Kelsey Wuensch for her editorial assistance.

Author contributions

TT-R drafted the manuscript, conducted the analysis and interpretation of the data for the work. YK contributed to interpretation of the data and critically revised the manuscript. MW contributed to data acquisition and critically revised the manuscript. JR contributed to the design of the study and critically revised the manuscript. KN contributed to conception of the study and data interpretation, and drafted the manuscript. JH contributed to study implementation, acquisition of the data and critically revised the manuscript, DM contributed to data interpretation and critically revised the manuscript. AF contributed to conception of the study data analysis, and critically revised the manuscript. AM contributed to conception and design of the study, data acquisition and analysis, and critically revised the manuscript. All gave final approval and agree to be accountable for all aspects of work ensuring integrity and accuracy.

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Correspondence to T Toro-Ramos.

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Competing interests

Noom, an independently owned and operated company, is the wellness programme that was offered to employees of Aetna customers in this study. There was no external source of funding for this study. The study was entirely supported by Aetna. Authors JR, KN and JH are employees of Aetna Inc. Authors TT-R, YK, MW, AF and AM are employees of Noom Inc.

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Toro-Ramos, T., Kim, Y., Wood, M. et al. Efficacy of a mobile hypertension prevention delivery platform with human coaching. J Hum Hypertens 31, 795–800 (2017).

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