Abstract
BACKGROUND: Effective hypertension management, particularly through self-care strategies, remains a significant public health challenge. Despite widespread awareness, only approximately 1 in 5 adults achieves adequate blood pressure (BP) control. There is a growing need for scalable digital health interventions that enhance awareness, support behavioral change, and improve clinical outcomes. However, real-world evidence evaluating the impact of such interventions on BP levels and their underlying mechanisms is limited. OBJECTIVE: This study aimed to evaluate the effectiveness of a digital intervention using data-driven nudges on monthly average BP levels. Specifically, we assessed changes in BP before and after the intervention and examined whether these changes differed compared to a control group in a high BP cohort and a normal BP cohort. METHODS: In this retrospective, real-world cohort study, we analyzed two user cohorts from a digital health platform: (1) individuals with high BP readings and (2) individuals with normal BP readings. Participants who received a digital intervention were propensity score-matched to users who did not receive the intervention, based on demographic and clinical variables. Monthly average BP and the proportion of high readings were assessed 3 months before and after the intervention. A piecewise mixed-effects model was used to evaluate BP trajectories, and simple slope analysis assessed the interaction between the outcomes and the groups, as well as the moderating effect of lifestyle activities on systolic blood pressure (SBP). RESULTS: In total, 408 users were included in the study. In the high BP cohort (n=296), the intervention group showed a significant decrease in the monthly average SBP after the intervention (B=-2.09; P<.001), while the control group showed a smaller reduction (B=-1.06; P=.007). Additionally, users reporting higher lifestyle activity levels experienced a greater reduction in SBP (B=-5.27; P<.001). In the normal BP cohort (n=112), the intervention group maintained stable BP levels after the intervention (B=-0.39; P=.27), while the control group exhibited a significant increase in BP levels (B=0.69; P=.03). CONCLUSIONS: Data-driven nudges delivered via a digital health platform were associated with improved BP outcomes among individuals with high BP levels and helped maintain BP stability among those with normal BP levels. These findings reinforce the integration of personalized digital interventions into hypertension management and highlight the potential role of positive messaging, behavioral engagement, and user empowerment in improving long-term outcomes.