Health Coaching on NexJ Connected Wellness Reduces Pre - Hypertension: A Population Health Study

Background: Hypertension affects millions worldwide, elevating stroke, and heart disease risks. While the transition from pre- to diagnosed hypertension can be prevented by lifestyle and pharmacological modifications, non-adherence to pharmacotherapy, physical activity, dietary, tobacco intake, alcohol intake, and stress reduction recommendations curtail this transition. Health coaching can function as an effective adjunct to primary-secondary medical care by increasing the adherence to lifestyle behaviors, pharmacotherapies. The objective of this paper is to evaluate the effectiveness of a multi-tier health coaching intervention, personalized for pre-hypertension involving three coaching intervention tiers of increasing intensity, assisted by a digital health platform. Methods Communities across Canada were recruited for Activate, a hypertension prevention program sponsored by the Heart and Stroke Foundation of Canada. Upon registration, participants were triaged to one of three coach intensity tiers based on self-reported adherence to physical activity, dietary, smoking, and stress management recommendations for hypertension prevention. Once triaged, they participated in a 6-month health coach intervention that included synchronous and asynchronous interactions with a personal health coach through NexJ Connected Wellness, a digital health platform. Participants were further provided with health education materials and the online tracking of health behaviors. Results Altogether, 4436 participants were recruited between May 2018 and January 2020. Results from 1113 participants (24% retention) demonstrated an overall mean reduction of 4.61mmHg in systolic blood pressure (SBP) from baseline with no difference between coaching intensity tiers. No significant between-tier differences were found in changes to blood pressure. 580 (52.1%) of participants demonstrated clinically-significant reductions (≥ 5 mmHg) in SBP. Conclusions A tiered approach that titrated coaching intensity according to participants’ adherence to lifestyle recommendations, demonstrated significant blood pressure reductions across different coaching tiers. Trial Registration ISRCTN26475151, Nov 28, 2025