Sustained Improvements in Salt Intake and Urinary Sodium-to-Potassium Ratio After Digital Therapeutics for Untreated Essential Hypertension: One-Year Results of a Prospective Study

Long-term maintenance of lifestyle modification is essential for hypertension management but is often difficult to achieve. Digital therapeutics (DTx) have emerged as a promising tool to support behavioral change; however, evidence regarding their long-term effectiveness remains limited. This study evaluated the one-year effects and sustainability of a hypertension treatment support application. This single-center prospective study included 18 untreated patients with essential hypertension (DTx group, n = 12; control group, n = 6). Office and home blood pressure, estimated salt intake, urinary sodium-to-potassium ratio, and body mass index were assessed at baseline, 6 months, and 12 months. The primary outcome was the between-group difference in change in office blood pressure. Office systolic blood pressure decreased similarly in both groups (DTx: from 144.0 [141.5–151.2] to 126.5 [122.2–137.2] mmHg at 6 months and 128.0 [123.2–133.5] mmHg at 12 months; control: from 149.0 [141.8–160.8] to 134.5 [133.2–135.8] mmHg at 6 months and 132.5 [128.2–148.8] mmHg at 12 months). No significant difference was observed in the primary outcomes. Similar findings were observed for diastolic blood pressure. Salt intake decreased in the DTx group from 8.8 [7.4–11.7] to 7.1 [6.5–8.4] and 7.0 [6.4–8.7] g/day at 6 and 12 months, respectively, whereas no meaningful change was observed in the control group from 9.3 [8.7–9.4] to 9.2 [9.0–10.3] and 9.6 [6.9–11.3] g/day, respectively. Improvement in the urinary sodium-to-potassium ratio was sustained only in the DTx group. In conclusion, this preliminary study suggests that DTx may facilitate sustained long-term dietary improvement in patients with mild or early-stage hypertension, warranting further investigation.