AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Six-Month Blood Pressure Trajectories and Wearable Correlates of Clinically Meaningful Blood Pressure Reduction in 20,003 Adults with Elevated Blood Pressure and Hypertension
By Cheung C, Cohen J, Curran D et al.
Introduction: Hypertension is a leading risk factor for cardiovascular disease. Digital health platforms have emerged as effective for hypertension management but often require dedicated clinical infrastructure. Consumer wearable platforms, which are widely adopted for everyday health monitoring and increasingly support blood pressure (BP) tracking, provide a scalable alternative for BP self-management which can be paired with continuous physiological monitoring. Hypotheses: We aimed to: i) characterize 6-month BP trajectories in a large free-living cohort of wearable device users with above-goal BP, and ii) identify wearable biometric and engagement factors associated with BP improvement at both the daily-level and over 6 months. We hypothesized that users would experience clinically meaningful reductions in BP over 6 months and that biometric and engagement metrics would be associated with these improvements. Methods: We retrospectively identified 20,003 adults aged 18-79 years (M/F: 18,382/1,621) with cuff-measured elevated BP (n=5,163), stage 1 hypertension (n=10,269), or stage 2 hypertension (n=4,571) who engaged with the wearable platform over 6 months. Change in BP over 6 months was estimated using linear mixed effects models (α=0.005). Mixed-effects models quantified within-person associations between day-level BP and concurrently measured wearable-derived biometrics across 132,843 BP readings collected over the 6-month period. At the participant level, logistic regression models identified 6-month biometric and engagement-based correlates of clinically meaningful BP reduction (≥5mmHg). Results: Systolic BP was reduced in all baseline strata at 6 months (Elevated: -2.48mmHg [95% CI: -2.77, -2.19]; Stage 1: -3.67mmHg [-3.88, -3.47]; Stage 2: -11.62mmHg [-11.92, -11.31]; p<0.001), and diastolic BP was reduced among individuals with Stage 1 and 2 hypertension (Elevated: 0.67mmHg [0.46, 0.89]; Stage 1: -3.24mmHg [-3.39, -3.08]; Stage 2: -8.45mmHg [-8.68, -8.22]; p<0.001). Within individuals, higher resting heart rate (SBP β=0.56 [0.47, 0.65]; DBP β=0.59 [0.53, 0.66]) and shorter sleep duration (SBP β=-0.13 [-0.19, -0.08]; DBP β=-0.07 [-0.11, -0.03]) were associated with higher day-level BP measurements (all p<0.001). Clinically meaningful reductions in BP at 6 months were predicted by change in resting heart rate (SBP: OR= 0.97 [0.96, 0.99]; DBP: OR=0.97 [0.95, 0.98]; both p<0.005) and average daily app engagement (SBP: OR= 1.14 [1.05, 1.25]; DBP: OR= 1.23 [1.12, 1.34]; both p<0.005) over the 6-month period. Conclusions: In a large cohort of adults with above-goal BP, clinically meaningful reductions in BP were observed over 6 months. Wearable-derived biometrics and app engagement were associated with BP improvement, supporting the potential value of consumer wearable platforms as a scalable approach for population-level BP self-management.