Association of an AI-Enabled Gamified Mobile Health App on Blood Pressure Outcomes in a Matched Cohort.

Authors

Michael Gottlieb, Kristen Pallok, Laura Zimmermann, Doug Thompson, David Ansell, Alexandra Weaver, Daisy Kersemakers, Katherine Niehaus, Garth Walker

Published in

Journal of general internal medicine. Sep 09, 2026. Epub Sep 09, 2026.

Abstract

Hypertension affects nearly half of adults in the USA and remains a major contributor to cardiovascular morbidity and mortality. Despite effective pharmacologic therapies, long-term blood pressure (BP) control remains suboptimal. Digital health interventions that support sustained self-management outside traditional clinical encounters may help address this gap. We evaluated whether engagement with a mobile health application integrating home BP monitoring, artificial intelligence (AI)-driven coaching, and behavioral incentives was associated with BP outcomes in routine clinical practice.
We conducted a retrospective propensity score-matched cohort study using EHR data from a large urban academic health system in the USA. Adults aged ≥ 18 years with hypertension who activated the Nuna Patient App between 04/11/2024 and 09/01/2025 were matched 1:1 to patients with hypertension receiving usual care. Participants were followed 6 months before and 6 months after app onboarding or a randomly assigned pseudo-engagement date for comparators. Primary outcomes were changes in mean systolic BP (SBP) and diastolic BP (DBP). Secondary outcomes included BP control (SBP < 140 mm Hg and DBP < 90 mm Hg) and reduction in SBP of at least 10 mm Hg.
After matching, 425 app users were compared with 425 usual care participants (mean age 59 years; 74% women; 65% Black). App users experienced greater reductions in SBP (-4.6 mm Hg vs -1.6 mm Hg; p = 0.003) and DBP (-2.5 mm Hg vs -0.9 mm Hg; p = 0.012) than matched controls. Among participants with uncontrolled stage 2 hypertension at baseline, SBP decreased by 13.6 mm Hg among app users compared with 9.0 mm Hg among controls (p = 0.009), and a larger proportion achieved BP control during follow-up.
Engagement with a gamified mobile health application incorporating AI-driven coaching was associated with greater improvements in BP compared with usual care, particularly among patients with uncontrolled hypertension. Digital interventions to support self-management behaviors may complement traditional care and improve BP outcomes at scale.

PMID:
42714818
Bibliographic data and abstract were imported from PubMed on 10 Sep 2026.

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