Higher Engagement in a Mobile Health Program Linked to Greater Blood Pressure Reduction in Mid-Life Women

A recent study evaluating engagement and blood pressure (BP) reduction in adults between the ages of 45 to 64 using a mobile health (mHealth) cardiovascular program found that female participants had higher engagement with the app and experienced greater reductions in systolic BP compared with their male counterparts. Engagement was found to mediate the relationship between sex and BP reduction, suggesting that digital health interventions could play a key role in supporting cardiovascular disease (CVD) prevention in this at-risk population. This study was presented at the American College of Cardiology's 74th Annual Scientific Session & Expo on March 29, 2025 in Chicago, IL.

Adults between 45 and 64 face an increased risk of CVD, with women experiencing a nearly threefold increased risk during and after menopause. While digital health interventions have demonstrated effectiveness in promoting self-management of CVD risk factors, there is limited research on how engagement and clinical outcomes vary by sex. Understanding these differences may help refine tailored prevention strategies and optimize digital health interventions for populations at greater risk. "This is incredibly important because during the period of perimenopause and menopause, a woman's blood pressure can begin to increase," said study author Jayne Morgan, MD, a cardiologist and Vice President of Medical Affairs at Hello Heart, in an interview with Consultant360. "We know that hypertension is a significant risk factor for heart disease and that heart disease remains the number one killer of women."

To evaluate the impact of engagement on BP reduction by sex, researchers analyzed real-world data from 8367 adults aged 45 to 64 years with uncontrolled BP at baseline who participated in an mHealth program for CVD risk management. Engagement was measured by the frequency of BP readings and interactions with in-app evidence-based insights. Researchers assessed differences in engagement levels and BP reduction between male and female participants and conducted mediation analyses to determine whether engagement influenced sex-related differences in BP outcomes.

At baseline, mean BP was 136.91 (SD = 12.58)/85.9 (SD = 9.00) mmHg, with no significant differences between men and women (t = 0.62, P = .53). After 1 year, women demonstrated a significantly greater reduction in systolic BP (B = -0.89, SEB = 0.28, t = -3.24, P = .001) and exhibited higher engagement in the app (t = -7.94, P = .008). Increased engagement was associated with larger BP reductions (B = -1.63, SEB = 0.21, t = -7.94, P < .001). Mediation analysis showed a significant indirect effect of sex on BP change through engagement (ACME = 0.067, 95% CI [0.024, 0.120], P < .001), indicating that engagement partially explained the greater BP reduction in women. However, the direct effect of sex on BP reduction remained significant (ADE = 0.659, 95% CI [0.117, 1.220], P = .026), suggesting that additional factors also contribute to these sex-based differences.

Dr Morgan emphasized the need for further research in this space: "Women have not traditionally been included in clinical trials. And when we do have clinical trials, they generally are confined to the areas of reproduction, even though heart disease is the number one killer of women. So even just getting that messaging out is critical."

“Among mid-life adults with uncontrolled BP using an mHealth program, females had higher engagement and greater systolic BP reduction than males,” the study authors concluded. “Engagement partially mediated the relationship between sex and BP reduction, indicating that app engagement could improve clinical outcomes and underscoring the potential of mHealth technology to support individuals during this period of increased CVD risk.”

Reference

Lyson H, Roberts W, Edo Paz Y, Morgan J. Engagement and blood pressure reduction among female participants of a mobile health cardiovascular program. Paper presented at: American College of Cardiology's 74th Annual Scientific Session & Expo;  March 29-31, 2025; Chicago, IL. Accessed March 20, 2025. https://accscientificsession.acc.org/