Dose-Dependent Associations Between Systolic Blood Pressure Reduction and User Engagement With a Wearable Cuffless Blood Pressure Monitor

Objective: Blood pressure (BP) control remains suboptimal, potentially due to limited user engagement with conventional cuff-based monitoring. Wearable, cuffless BP monitors facilitate sustained user engagement with self-monitoring and may thus improve BP control. In this retrospective study, we investigated the association between levels of user engagement with a wearable BP monitor and six-month changes in systolic BP (SBP). Design and method: Thirty thousand individuals who acquired and routinely used the Hilo BP monitor (Aktiia SA, Switzerland) between 2022 and 2025 were included in the analysis. The monitor consists of a wearable band (used for continuous 24/7 measurement of BP) and an upper-arm oscillometric Cuff (for monthly initialisation/calibration, each session with three repeated cuff-based measurements). SBP from initialisation sessions were collected throughout the six months. Six-month SBP change was calculated as the difference between mean SBP values recorded during the sixth month and the first session, requiring at least one initialisation session in the sixth month. User engagement was defined as the average number of daily accesses to the Hilo mobile App over the six-month period, categorised into percentiles. Engagement association with changes in SBP were evaluated using regression analysis. Results: In the overall cohort (N=30,092), each additional daily app access was associated with a 0.98 mmHg SBP reduction over six months (p<0.0001). This resulted in a reduction of ∼8 mmHg for users that engaged 6 times per day compared to ∼2 mmHg for 0.5 times per day, see figure below. This engagement-associated SBP reduction varied by baseline SBP category: 0.88 mmHg reduction per additional daily access for hypertensive (SBP>140 mmHg; N=11,178; p<0.0001) and 1.15 mmHg for severe hypertensive (SBP>160 mmHg; N=2,126 p<0.0001) subgroups. In normotensive users (SBP<120 mmHg; N=3,931), effect size and the model were not statistically significant.Conclusions: Higher levels of user engagement with a wearable, cuffless BP monitor were associated with greater reductions in SBP within the first six months of use, more so amongst severely hypertensive individuals. If broadly adopted by hypertensive populations, engagement-driven BP reductions could be associated with better BP control and potentially decreases in CV events and associated healthcare cost.