In a 954-person, three-arm RCT of adults aged ≥55 with metabolic syndrome risk factors, all intervention groups achieved meaningful cardiometabolic improvements over 12 weeks. Systolic blood pressure fell 4.84–7.15 mmHg across groups, and waist circumference shrank 4.69–6.29 cm. The group receiving dietetic counseling plus a web platform plus wearable devices showed a statistically significant additional reduction in pulse pressure (−3.90 mmHg; 95% CI −6.58 to −1.22) and a meaningful boost in physical activity (+94.62 MET-min/week) compared with standard care alone. Weight loss emerged as the dominant driver: each unit of weight reduction was associated with 60% lower odds of hypertension (OR 0.4), 3.6-fold greater odds of hypertension reversal, and 1.8-fold higher probability of achieving normal pulse pressure.
The headline takeaway is both encouraging and sobering. Dietetic counseling alone delivers clinically relevant blood pressure reductions—comparable to low-dose antihypertensive monotherapy—confirming that structured dietary guidance remains the cornerstone of lifestyle-based hypertension management. The modest incremental benefit of adding digital tools (wearables plus a web platform) is real for pulse pressure, an independent marker of arterial stiffness and cardiovascular risk, but the magnitude is small and the primary driver remains weight loss rather than the technology itself. This is an important corrective to current enthusiasm for mHealth as a transformative intervention. Limitations include the relatively short 3-month duration, the Greek-specific sample limiting global generalizability, and the lack of blinding inherent to behavioral RCTs. Nonetheless, the trial's size and randomized design make it one of the more rigorous evaluations of digital adjuncts to dietary counseling yet published.