AI Lifestyle Coach Can Help Improve Outcomes in Patients With Hypertension

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After 24 weeks of participation in an AI-driven lifestyle coaching program, 78% of all participants achieved a clinically meaningful SBP reduction of 5 mm Hg or greater.

A fully digital, artificial intelligence (AI)-driven lifestyle coaching program can effectively reduce blood pressure (BP) and enhance patient engagement in adults with hypertension, according to a new study published in JMIR Cardio.1

Wearable activity tracker with heart health interface / tong4130 - stock.adobe.com

Wearable activity tracker with heart health interface / tong4130 - stock.adobe.com

“By pinpointing the top lifestyle contributors to patients’ hypertension and providing precise guidance, the AI-powered lifestyle coaching was able to maintain high patient engagement leading to improved patient outcomes,” said Jared Leitner, MD, lead study investigator, in a news release.2 “This study demonstrates how an AI-based, autonomous approach to hypertension-related lifestyle coaching can increase scalability and accessibility to effective blood pressure management.”

About the Trial

Trial Name: An Artificial Intelligence-Assisted Digital Health Lifestyle Intervention for Adults With Hypertension

Clinicaltrials.gov Identifier: NCT06337734

Sponsor: University of California, San Diego

Summary: This study evaluates the impact of a fully digital, autonomous, and artificial intelligence (AI)-driven lifestyle coaching program on managing blood pressure (BP) among adults diagnosed with hypertension.

Home BP monitoring is often combined with lifestyle coaching to manage hypertension and reduce cardiovascular risk. However, limitations such as high operating costs and personnel requirements limit the availability and scalability of such programs. Further, a lack of patient lifestyle monitoring and clinician time constraints can lead to inconsistencies in patient monitoring and lackluster health recommendations.

To address these limitations, researchers investigated the potential of an AI-supported, autonomous, precise lifestyle coaching program to yield better cardiovascular outcomes. This program sought to overcome the hurdles associated with traditional methods of management, such as clinician reliance and time constraints.

Between the recruitment period of November 2021 to February 2023, 141 participants with either stage-1 or stage-2 hypertension, aged 18 years or older, and who owned a smartphone, were enrolled in the single-arm, nonrandomized, fully remote trial (NCT06337734).

Participants were sent a wearable activity tracker and BP monitor to collect their lifestyle and BP data over 24 weeks; 3 BP readings were taken during each morning (8 AM-10 AM) and evening (7 PM-9 PM) session, and the average of the 3 measurements were used as the final value for each session.

Participants were also tasked with answering a daily questionnaire through the study’s mobile app on questions about stress, mood, and dietary choices, including alcohol, red meat, fruits and vegetables, and salt consumption. To glean adherence to program tasks, participants completed an experience survey at the end of the assessment period.

READ MORE: Swipe Right on Wellness: The Rise of Digital Therapeutics in Mental Health

Each participant’s data was used to train a personal machine learning model that worked alongside the study’s mobile app to analyze how different aspects of participants’ lifestyles affected their BP. The app generated tailored recommendations for each participant based on this analysis.

Recommendations were delivered every week via text—paired with a motivational message regarding participants’ progress—and changed over time as progress was tracked by the app. “The objective of these precise lifestyle recommendations is to encourage participants to concentrate on 1 aspect of their lifestyle at a time, focusing on the factor that has the greatest association with their BP based on the underlying relationship between their BP and lifestyle factors,” wrote investigators.1

At 24 weeks across all participants, there was a statistically significant decrease in systolic BP (SBP) and diastolic BP (DBP) of 8.1 mm Hg (95% CI −10.1 to −6.1; P <.001) and 5.1 mm Hg (95% CI −6.2 to −3.9; P <.001), respectively. This improvement was more pronounced in participants with stage-2 hypertension, with the subpopulation demonstrating a statistically significant decrease in SBP and DBP of 14.2 mm Hg (95% CI −17.7 to −10.7; P <.001) and 8.1 mm Hg (95% CI −10.4 to −5.7; P <.001), respectively.

Strikingly, 65% and 78% of all participants achieved a clinically meaningful SBP reduction of 5 mm Hg or greater after 12 and 24 weeks, respectively. Investigators noted that these changes are significant based on findings from a previous meta-analysis of 48 randomized clinical trials that suggested that a 5 mm HG decrease in SBP translates to a 10% lower risk of major cardiovascular events.3

The study also observed both a high (92%) weekly engagement rate and minimal need for clinician intervention. This was attributed to the personalized advice, ease of compliance, and motivational reinforcement offered by the program, all of which contributed to strong task completion. Further, these findings indicate the potential of fully digital AI-based lifestyle coaching to achieve high engagement while alleviating the workload of health care professionals.

Hypertension, one of the most prevalent chronic diseases in the world, exacts a significant financial burden on the US health care system, resulting in an additional $131 billion in annual spending for management of the condition.4 With its rising prevalence, this financial burden underscores the urgent need for scalable solutions to effectively manage hypertension from a public health perspective.

"As the burden of hypertension increases globally, the necessity to develop new strategies to achieve hypertension control at scale is greater than ever,” investigators concluded.1 “An AI-based, autonomous approach to hypertension-related lifestyle coaching can increase the scalability and accessibility of effective BP management, ultimately improving the cardiovascular health of our community.”

READ MORE: Cardiology Resource Center

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References
1. Leitner J, Chiang P, Agnihotri P, Dey S. The effect of an AI-based, autonomous, digital health intervention using precise lifestyle guidance on blood pressure in adults with hypertension: Single-arm nonrandomized trial. JMIR Cardio. 2024;8:e51916. doi: 10.2196/51916
2. AI health coach lowers blood pressure and boosts engagement in patients with hypertension. News release. EurekAlert. May 29, 2024. Accessed May 30, 2024. https://www.eurekalert.org/news-releases/1046250
3. Blood Pressure Lowering Treatment Trialists' Collaboration. Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis [published correction appears in Lancet. 2021 May 22;397(10288):1884]. Lancet. 2021;397(10285):1625-1636. doi:10.1016/S0140-6736(21)00590-0
4. Kirkland EB, Heincelman M, Bishu KG, et al. Trends in Healthcare Expenditures Among US Adults With Hypertension: National Estimates, 2003-2014. J Am Heart Assoc. 2018;7(11):e008731. Published 2018 May 30. doi:10.1161/JAHA.118.008731
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