Hypertension (High Blood Pressure)
Hypertension is high blood pressure in your blood vessels. It affects nearly 1 out of every 3 American adults, and another 1 out of 3 are pre-hypertensive and at risk for developing hypertension. High blood pressure puts you at risk for stroke and heart disease, which are two of the top 3 causes of death in the U.S., and the Centers for Disease Control and Prevention, or CDC, reports that it is responsible for over 1,000 deaths every year.
Hypertension is largely treatable with lifestyle and medications, but only slightly over half of people with hypertension have their condition under control. That puts them at higher risk for complications, but you can work to stay healthy by monitoring your numbers, considering healthy lifestyle changes, and following your doctor’s orders. Tools such as health apps can help you.
Add anything else relevant that you might pick up (like headaches stuff or maybe history?) that I might not have included in my outline.
What Is Hypertension?
Hypertension is higher-than-normal pressure in your blood vessels. The pressure is measured as the force of the blood against the wall of your blood vessels, usually your arteries, which carry oxygenated blood to your body organs and tissues.
You will usually see your blood pressure reading as one number over another. The top number is the systolic blood pressure, which is the force as your heart contracts and pushes blood through your body. The bottom number is the diastolic blood pressure, which is the force as your heart relaxes.
These are the standard classifications for normal and high blood pressure.
· Normal blood pressure: 90/60 to under 120/80 mm Hg.
· Prehypertension, or risk for hypertension: 120-139/80-89 mm Hg.
· Stage 1 hypertension: 140-159/90-99 mm Hg.
· Stage 2 hypertension: over 160/100 mm Hg.
If your systolic and diastolic blood pressure are in two different categories, doctors consider the number that is in the higher category. For example, if your blood pressure is 135/91, your systolic blood pressure is in the prehypertensive range and your diastolic blood pressure is in the range of Stage 1 hypertension. Your measurement or 135/91 would place you in the category of Stage 1 hypertension.
Stage 1 and Stage 2 Hypertension
Stage 1 hypertension is when your blood pressure is 140-159/90-99 mmHg. You would also be considered to have stage 1 hypertension if your systolic blood pressure is 140-159 and your diastolic blood pressure is under 90, or if your diastolic blood pressure is 90-99 and your systolic blood pressure is under 140.
Stage 2 hypertension is when your blood pressure is over160/100 mmHg, or if your systolic blood pressure is over 160, or if your diastolic blood pressure is over 100. Stage 2 hypertension puts you at higher risk for complications of high blood pressure than stage 1 hypertension does.
What Is Essential Hypertension?
Essential hypertension is also known as primary hypertension. Over 9 out of 10 cases of hypertension are essential, and this is the kind of hypertension most people are referring to when they talk about “hypertension” or “high blood pressure.” This kind of hypertension is the direct result of factors such as lifestyle choices or genetic factors. Related lifestyle factors can include the following.
· Being overweight.
· Have a high-sodium diet or other poor dietary patterns.
· Have a low-activity lifestyle.
· Lack of sleep.
In contrast to essential hypertension, secondary hypertension is high blood pressure that occurs due to the effects of another condition or medical cause, such as kidney disease, adrenal disease, or medications, such as some over-the-counter painkillers and oral contraceptive pills.
What Is Pulmonary Hypertension?
Pulmonary hypertension, or pulmonary arterial hypertension, is high blood pressure in the artery that carries blood from your heart to your lungs to get oxygen to transport to the rest of the body. Normal blood pressure in this artery while you are at rest is 8 to 20 mm Hg. You have pulmonary hypertension if your measurement is at least 25 mm Hg while you are at rest, or at least 30 mm Hg while you are exercising.
Similar to primary hypertension, pulmonary hypertension can happen when the arteries tighten or become stiff, or if blood clots form in the area. It can be caused by genes or lifestyle. You are at higher risk if you use street drugs or live at a high altitude.
What Is Orthostatic Hypertension?
Orthostatic hypertension is a rare condition of increased blood pressure when you stand up. It is a rare condition that is defined by an increase of at least 20 mm Hg when going from a laying (“supine”) position to standing. It is most related to essential hypertension and diabetes.
Orthostatic hypotension, or sudden low blood pressure upon standing up, is far more common than orthostatic hypertension. It is also called postural hypotension, and can cause dizziness, confusion, and weakness.
What Is Portal Hypertension?
Portal hypertension is high blood pressure in the portal venous system. This is the system comprising veins from various organs in the digestive system, including the stomach, pancreas, spleen, and small intestine. These blood vessels come together as the portal vein, which brings blood to the liver. The blood vessels branch into smaller ones, and portal hypertension occurs if the flow of these vessels is blocked, which can happen as the result of liver damage.
What Is Malignant Hypertension?
Malignant hypertension is a rare but serious condition that requires immediate medical attention. It occurs when your blood pressure suddenly rises to at least 180/120. If this condition is not treated immediately, it can lead to serious organ damage, such as the following.
· Kidney failure
· Heart attack
Hypertension is a risk factor for malignant hypertension, and skipping hypertension medications raises your risk. However, malignant hypertension occurs in fewer than 1 out of 100 people with hypertension. Kidney disease, sclerodoma, spinal cord injuries, and certain drugs or medications can cause it. You are also at higher risk if you are male, African American, or of lower socioeconomic status with less access to healthcare.
What Is Idiopathic Intracranial Hypertension?
Idiopathic intracranial hypertension, also known as intracranial hypertension, is the result of high pressure in the cerebrospinal fluid, or the fluid that fills the spaces surrounding the brain and spinal cord.
The National Eye Institute of the National Institutes of Health (NIH) reports that about 100,000 people have idiopathic intracranial hypertension. Over 90% of these are women. Obesity, or a BMI over 30, is a risk factor. So is regaining 5 to 15% of body weight if you have previously lost weight. Some medications can cause intracranial hypertension, too.
The symptoms of hypertension depend on which kind you have and how severe it is. You may not have any signs of high blood pressure, or you could notice hypertension symptoms in your day-to-day activities.
Symptoms of Primary Hypertension
Hypertension is known as “the silent killer” because you can have it without knowing it. You cannot depend on specific hypertension symptoms to let you know that you have high blood pressure. That means you could be at risk for complications such as stroke or kidney disease without realizing it.
The American Heart Association, or AHA, explains that the early signs of hypertension that people tend to think about are largely mythical. You are unlikely to notice “classic” signs such as anxiety, insomnia, or flushing in your face. You could have blood spots in your eyes due to subconjunctival hemorrhage. Dizziness itself is not among the essential hypertension symptoms, but it could be a sign of stroke.
Symptoms of Pulmonary Hypertension
Early signs of pulmonary arterial hypertension can be related to the trouble you have getting blood to your lungs to get oxygenated. You might experience shortness of breath and a fast heart beat while doing activities that are otherwise routine, such as climbing stairs. You might also have chest pain, a reduced appetite, and pain in your chest or upper right portion of your abdomen.
Pulmonary arterial hypertension symptoms can develop into light-headedness and fainting. Your lips and skin might have a bluish tinge because of the lack of adequate oxygenation of your blood.
Symptoms of Orthostatic Hypertension
Early signs of orthostatic hypertension can include an intense headache that throbs, and possibly blurry vision. Orthostatic hypertension symptoms can also include poor circulation and narrowing of the arterioles.
Symptoms of Portal Hypertension
You may not have specific early signs of portal hypertension, but since the condition is usually caused by cirrhosis of the liver, you are likely to have portal hypertension if you have cirrhosis. You might have the following portal hypertension symptoms.
· Bleeding in the gastrointestinal tract with bloody stools or vomit.
· Low platelet count or reduced blood clotting ability.
· Low white blood cell count, which can lead to more infections, since white blood cells are immune cells
· Confusion or encephalopathy related to lower liver function.
· Fluid in the abdomen, or ascites.
Your doctor might perform angiography, an ultrasound, or an endoscopy to help diagnose portal hypertension.
Symptoms of Malignant Hypertension
Because of the need for emergency care, it is important to recognize the early signs of malignant hypertension. The first giveaway is blood pressure of 180/120. You might have bleeding in the eyes due to rupture of the small blood vessels. Other malignant hypertension symptoms can include chest pain, dizziness, a headache, numbness in your extremities, and confusion.
Symptoms of Idiopathic Intracranial Hypertension
Early signs of idiopathic intracranial hypertension can include trouble with your vision, such as periodic episodes of blindness, blind spots, trouble with your peripheral (side) vision, and double vision. Other common idiopathic intracranial hypertension symptoms include:
· Ringing in your ears, or tinnitus.
· Pain in your shoulders or neck.
Headaches strike over 90% of adults each year. You may be able to wait out some and let them pass, but others may be a sign that your body is asking you to take action. There is a chance that your headache could be a sign of high blood pressure. If there are no other causes of your headache, you should ask your healthcare provider about getting your blood pressure checked.
2018 Hypertension Clinical Guidelines
Hypertension clinical guidelines from the American Heart Association are comprehensive guidelines for healthcare professionals for the detection and treatment of high blood pressure in a wide range of patients. Included in the 2018 hypertension clinical guidelines are proper methods for measuring blood pressure, risk factors for hypertension, and hypertension treatment for different populations.
These guidelines help guide healthcare practices, and can be related to patient reimbursement and healthcare coverage. The tenth revision of the International Statistical Classification of Diseases and Related Health Problems, or ICD-10, is the set of codes used to designate specific health conditions and allow for reimbursement through health insurance programs.
There are a few hypertension ICD-10 codes. The code for essential primary hypertension without comorbidities is I10. A patient with hypertension and heart disease would qualify for I11.9 or I11.0, depending on if she had heart failure as well. Other ICD-10 codes consider hypertension with or without chronic kidney disease and kidney failure.
Hypertension Risk Factors
Since you are unlikely to have symptoms of hypertension, it is good to learn the risk factors so you have some idea of your risk. You should contact your healthcare provider if you have prehypertension or high risk for hypertension. Even if your risk is low, you should find your blood pressure so you have a baseline to work from so you can stay healthy in the future.
Non-Modifiable Risk Factors for Hypertension
The risk factors for high blood pressure include both genetic factors as well as modifiable factors, or factors that can be controlled. These are the factors you cannot control.
· Family history: you are more likely to develop high blood pressure if your parents or siblings did.
· Age: your risk increases as you get older.
· Race: African Americans are more likely to get high blood pressure and complications from it.
Non-Modifiable Risk Factors for Hypertension
Modifiable risk factors for hypertension are factors that you can control. Learning about these can help you identify areas in your life where you could change some things to lower high blood pressure or lower your risk for high blood pressure. These are some lifestyle-related risk factors for hypertension.
· Obesity. Extra weight requires extra blood volume to circulate oxygen to your tissues, which causes extra pressure in your blood vessels. A BMI of 30 or over corresponds to a weight of 180 lb. for someone who is 5’6” or 209 lb. for someone who is 5’10.”
· Lack of physical activity. Your heart must work harder to pump blood through your body, and force on your arteries is higher.
· A high-sodium, low-potassium diet. Sodium, which is mostly found in salt, raises blood pressure by increasing water retention and blood volume, while potassium has the opposite effect.
· Use of tobacco. Smoking and chewing tobacco raise blood pressure and damage your arteries.
· Excessive alcohol consumption. Moderate consumption of red wine can be good for your heart in some cases, but alcohol abuse over time can raise blood pressure.
Hypertension at Work
There has been some attention towards high blood pressure at work. It makes sense, since work can be stressful. Even a job you love can take time away from your family and leisure time while demanding effort and enforcing tight deadlines. Worse, jobs could involve unpleasant coworkers, unrealistic workloads, and high-pressure bosses.
You may suspect that your job raises your blood pressure, and there is some evidence that that could happen. Working too many hours, being around people you find unpleasant, and being in a high-strain job can all increase hypertension risk. So can the perception that work takes away from your time at home.
Hypertension Prevention and Treatment
Many of the strategies for hypertension prevention and treatment are similar. They focus on healthy lifestyle changes and behaviors. The following strategies can be good for your blood pressure.
· Losing extra weight
· Increasing diet quality.
· Increasing physical activity.
· Avoiding tobacco use.
· Getting enough sleep.
· Managing stress.
· Monitoring blood pressure.
Losing Extra Weight
Extra weight is a major risk factor for hypertension. While weight loss is difficult for many people, it can be easier to focus on small goals. Losing just a little bit of extra weight can help, since each kilogram (2.2 lb.) can lead to a 1-point decrease in blood pressure.
Small changes can help you lose weight over time.
· Drink more water. It helps reduce hunger.
· Fill your plate with non-starchy vegetables, since they are low-calorie and filling.
· Consider lower-calorie swaps, such as fatty meats for skinless poultry and fish.
· Bake, grill, roast, or steam instead of fry.
· Limit high-calorie, low-nutrient foods such as desserts, butter, and fried foods.
Weight loss support can keep you motivated and on track. When you have a health coach available to you 24/7, you can depend on help when you need it for handling cravings and staying motivated. Lark health coach also tracks your weight and progress towards weight goals, and offers advice for good food choices for weight loss.
Increasing Diet Quality
Most Americans get too much sodium and not enough potassium, and that can be a blood pressure-raising combination. Shifting the balance can help lower blood pressure by a few points. These choices can help you change the balance to get more potassium and less sodium.
· Consume more beans, vegetables, fruit, fish, and yogurt.
· Limit processed and prepared foods, such as canned foods, snack foods, processed meats, and frozen foods.
· Limit prepared foods, such as fast food and deli salads.
· Limit salty foods, such as salty sauces and dressings, cheese, and pickles.
Sodium and potassium may be the nutrients you hear about most often for blood pressure, but other nutrients can also help keep your numbers in check.
· Vitamin C: in vegetables and fruit.
· Vitamin D: in fortified milk and fatty fish.
· Fiber: in vegetables, beans, nuts, whole grains, and fruit.
· Calcium: in dairy products, dairy substitutes, and leafy greens.
As you think about boosting good nutrients, you can also think about limiting the bad ones.
· Choose lean meats and fish instead of fatty cuts.
· Choose lower-fat dairy products.
· Swap olive oil, avocados, and nut butters for butter, shortening, and lard.
· Take fruit instead of baked goods or ice cream for a sweet treat.
· Look for whole grain versions instead of opting for refined cereal and white bread, pasta, and rice.
The Dietary Approaches to Stop Hypertension, or DASH, diet is a meal plan that can help you get more of the blood pressure-lowering nutrients and less of the blood pressure-raising villains. A clinical trial found that the DASH diet can lower blood pressure within weeks.
It is higher than the average diet in vegetables, fruit, and dairy products. It is lower than the average diet in added sugars, refined starches, and red meat. You can follow a DASH diet by including the following foods in your regular plan.
· 6 1-ounce servings of grains per day – focus on whole grain options.
· 4 to 5 servings of vegetables per day.
· 4 to 5 servings of fruit per day.
· 2 to 3 servings of low-fat dairy products per day.
· Up to 6 1-ounce servings of lean meat, poultry, or fish per day.
· 4 servings per week of nuts and seeds.
· 2 to 3 servings per day of healthy fats and oils.
This may seem like a lot to remember, but you do not need to do it on your own. Lark health coach can help you follow a DASH-style diet while considering your individual lifestyle. The app encourages healthier choices on a daily basis.
Increasing Physical Activity
Exercise lowers blood pressure by nearly 10 mm Hg, so adding exercise to your regular schedule can help prevent or treatment hypertension. The general recommendation for aerobic exercise is to get at least 30 minutes of moderate-intensity exercise at least 5 days a week, or at least 15 minutes of vigorous-intensity exercise at least 5 days per week. You can try:
· Walking or jogging.
· Bicycling indoors or on a stationary bike.
· Using an elliptical, stair climbing, or rowing machine.
· Taking aerobics or other group fitness classes.
· Swimming or doing water aerobics.
You can also improve general health and lower blood pressure by incorporating strength training into your routine at least twice a week. Weights such as dumbbells, barbells, and weight machines can work, but so can body weight exercises, resistance bands, and medicine balls.
Starting and especially maintaining an exercise program can be challenging, but you can set yourself up for success.
· Make it fun to stay motivated. Keep trying until you find something you love. It could be walking, but it could be something as unexpected as circus classes for exercise.
· Involve others. Get a friend to join you so you are less likely to skip your workout, and more likely to complete the whole thing.
· Add it your schedule and keep the commitment, just like you do with brushing your teeth, attending important meetings at work, and getting your children to their activities.
· Use a smartphone app such as Lark. This health coach can motivate and remind you to get active, help you set and achieve activity goals, and track your activity.
According to the National Heart, Lung, and Blood Institute of the NIH, you can get started with an exercise program if you are generally healthy. However, you should check with your healthcare provider first if you are over 50, have a heart condition or another health condition, or have a family history of heart disease.
Avoiding Tobacco Use
Smoking can increase your risk for hypertension, not to mention heart disease, stroke, cancer, and other conditions. A study published in the journal of the AHA, “Hypertension,” found that normotensive smokers who quit smoking for a week reduced their blood pressure by nearly 4 points systolic and 2 points diastolic. Avoiding chewing tobacco and secondhand smoke can also lower blood pressure or risk for hypertension.
Getting Enough Sleep
Sleep is more than just a luxury or an escape. It is a necessary component of a healthy lifestyle if you want to lower risk for conditions including diabetes, obesity, heart disease, and blood pressure. Even a night of sleep deprivation can interfere with your body’s ability to control blood pressure, and being chronically short on sleep can increase hypertension risk.
Many adults fall short of their recommended amounts of sleep, but you can take steps to get adequate shut-eye.
· Have a consistent bed-time.
· Follow a relaxing pre-bed routine.
· Be sure your bedroom is dark, quiet, and cool.
· Avoid phone, computer, and TV screens 30 minutes before bed.
· Use a health coach that also tracks sleep.
You may not be surprised to learn that stress can contribute to increases in blood pressure, both in the moment and over time. Stress from jobs, relationships, financial pressures, and other aspects of life can be harmful. Some of it is unavoidable, but the good news is that research suggests that how you respond to stress affects how much harm the stress does.
Learning to manage stress can be well worth it. These are some common and helpful approaches.
· Exercise regularly.
· Relax with stretching, massage, or a hot bath.
· Use deep breathing techniques.
· Talk yourself through it.
· Phone a friend.
It can be hard to learn how to manage stress, but practice helps. Lark health coach can also help by letting you identify when you are stressed and offering suggestions for staying calm and in control in the moment.
Monitoring Blood Pressure
Taking regular blood pressure readings can help you keep blood pressure down. Those readings act as reminders to keep up with your healthy lifestyle and any medications. They also let you learn patterns, so you can easily know if something is wrong and it is time to contact your healthcare provider.
If you have hypertension, taking blood pressure twice a day can be burdensome because it is hard to remember, but you can get help. Your Lark health coach can remind you and automatically store your measurements so you can see trends and share them with your doctor.
In addition, your healthcare provider might prescribe hypertension medications if you are unable to control your blood pressure with these lifestyle strategies.
Pulmonary Hypertension Treatment
Pulmonary arterial hypertension has no cure. Instead, the goal of pulmonary hypertension treatment is to slow its progression. Your doctor might prescribe hypertension medications such as diuretics or blood thinners, or put you on oxygen therapy to reduce breathlessness. You might have to limit your activities to prevent fainting, although a safe level physical activity can help delay progression of the condition.
Orthostatic Hypertension Treatment
Treatment of orthostatic hypertension can include home monitoring and use of medications such as doxazosin to lower blood pressure by blocking sympathetic nervous system activity. The goal is to reduce the risk of complications such as protein in the urine, or albuminuria, or damage to the heart. Treatment also includes treating the conditions that may have caused the high blood pressure, such as loss of blood volume. This could involve IV fluid provision.
Portal Hypertension Treatment
Since the condition cannot be cured, portal hypertension treatment focuses on managing complications such as variceal bleeding. Along with beta blockers and a good diet and exercise program for hypertension, portal hypertension treatment can include the following.
· Lactulose, a medication to reduce forgetfulness and other symptoms of encephalopathy.
· Banding, which is a form of endoscopy involving the use of bands to block off varicose veins and reduce bleeding.
· Sclerotherapy, which is another form of endoscopy. It involves injecting a solution into the veins to stop bleeding.
· Transjugular intrahepatic portosystemic shunt (TIPS) or Distal splenorenal shunt (DSRS), which involve placing a stent to reroute blood flow to and within the liver to relieve pressure.
Malignant Hypertension Treatment
Malignant hypertension treatment can be done in a hospital setting, even in the intensive care unit, since it is a medical emergency. The goal is to lower your blood pressure to a safe level as quickly as possible, without doing damage.
Idiopathic Intracranial Hypertension Treatment
Intracranial hypertension treatment is likely to include an eye exam and vision tests. If the condition was caused by a medication you were taking, your healthcare provider might look into alternatives so you can stop that medication. Weight loss and reduction of sodium intake are other strategies for idiopathic intracranial hypertension treatment. A medication to reduce cerebrospinal fluid production and surgery to reduce pressure on your optic nerve and preserve eyesight are also possibilities.
Lifestyle changes such as choosing a healthier diet, losing a bit of extra weight, quitting smoking, and getting more exercise can be quite effective, but hypertension medication can be necessary if lifestyle changes do not get your blood pressure down to your goal range.
Types of Hypertension Medications
A number of different hypertension medications are common.
· Thiazide diuretics. Diuretics help your kidneys rid your body of extra water and sodium. This leads to a smaller blood volume, less force of blood against your vessels, and lower blood pressure. Side effects can include dehydration, dizziness, and muscle cramps.
· Beta blockers. These medications are also called beta-adrenergic blocking agents. They reduce the effects of adrenaline, also called epinephrine, which helps your heart beat more slowly and less forcefully to reduce blood pressure. Side effects can include weight gain, fatigue, and cold feet and hands.
· Angiotensin-converting enzyme (ACE) inhibitors. Angiotensin II is a substance in your body that raises blood pressure by constricting, or narrowing, your blood vessels and increasing levels of blood pressure-raising hormones in your body. ACE inhibitors block your body from producing as much angiotensin II, so your blood pressure decreases. Side effects are not very common, but can include fatigue, dizziness, headaches, and coughing.
· Angiotensin II receptor blockers (ARBs). These medications have similar effects of ACE inhibitors, but they work not by reducing angiotensin production, but by blocking the action of angiotensin on blood vessels. Side effects can include dizziness, weakness, and gastrointestinal distress.
· Calcium channel blockers. These medications are used to relax the muscles of blood vessels. They can also slow your heart rate. Side effects can include constipation, headaches, dizziness, and nausea.
Your doctor might prescribe more than one type of medication if your blood pressure does not respond to the first one you are prescribed.
Non-Adherence as a Challenge with Hypertension Medications
Medications as hypertension treatments can be effective, but they do have some intrinsic problems. All drugs carry risks of side effects, complications, and the potential to interact with medications or supplements.
A major concern with hypertension medications is patient adherence. Compliance rates can be low, as patients may not follow their healthcare providers’ instructions for taking their medications in the proper doses, or they may skip doses because they forget. The results can include lower effectiveness of the drug therapy, and higher risk for hypertension complications such as stroke and heart attacks.
Technology such as smartphone apps can assist in reducing behaviors to patient compliance, particularly when the reason for non-adherence is forgetfulness.. Lark Hypertension Pro, for example, reminds patients when to take each dose of their medications according to the information users provide.
Getting Help for Hypertension Prevention and Treatment
Healthy lifestyle changes can be effective for preventing and treating essential and other types of hypertension, but they can be difficult for people to implement on their own. You can find help for making healthy changes, though.
Lark Hypertension Pro, for example, is a health coach for essential hypertension treatment. It offers help for a variety of approaches to support healthy blood pressure.
· Support and tracking for weight loss.
· Healthy diet information and tips.
· Physical activity tracking and tips.
· Stress reduction strategies.
· Healthy sleep tips and tracking.
· Reminders to measure blood pressure, and storage of your data.
· Medication reminders.
· Help connecting with a healthcare professional if your blood pressure is out of range.
High blood pressure may be “the silent killer,” but you can stand up loud and clear against it. Take charge of your blood pressure by knowing your risks, doing what you can to prevent and control hypertension, and working with your healthcare provider.
2. Best hypertension management health coach app
You are putting in the work, so you deserve to maximize the benefits. A weight loss health coach app can help you do just that. A health coach app serves all the functions of a regular coach: informing, motivating, guiding, cheering, and organizing. The best weight loss health coach app:
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· Motivates you to keep setting and chasing new goals.
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· Cheers your successes, your efforts, and, should you fall short of your goals for a time, your renewed dedication.
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Lark Health Coach serves all of those roles, and then some. Lark is available 24/7 to be your coach and friend. Your health coach automatically customizes your program for you.
Lark even learns your patterns and coaches around them. Do you prefer a gluten-free or dairy-free lifestyle? You’ll get tips on healthy ways to get your nutrients without eating gluten or dairy products. Do you normally take an afternoon walk? Then do not be surprised if Lark gives you a gentle nudge if you forget to take it one day.