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

Abstract Background 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. Methods 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. Findings 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. Interpretation 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.