A new study presented at the American Heart Association’s Scientific Sessions 2025 reveals that offering daily cash rewards doubled the likelihood of patients taking their blood pressure medication, yet did not lead to significantly better blood pressure reductions compared to a control group. The findings, published simultaneously in the Journal of the American College of Cardiology, highlight the complexity of improving long-term health outcomes through financial incentives.
The Behavioral Economics Trial To Enhance Regulation of Blood Pressure (BETTER-BP) study included 400 adults with high blood pressure from three community health clinics in New York City. Participants were predominantly low-income or uninsured, groups known to have higher rates of uncontrolled blood pressure and inconsistent medication use. Two-thirds were randomized to a rewards group where they could win $5 to $50 daily if electronic pill bottles recorded they had opened their medication the previous day. The control group received no incentives.
After six months, 71% of the rewards group consistently opened their pill bottles (at least 80% of days), compared to 34% in the control group. However, systolic blood pressure reductions were similar: an average drop of 6.7 mm Hg in the rewards group versus 5.8 mm Hg in controls. When the rewards ended, adherence in the incentive group returned to baseline levels.
“We were surprised that the behavior change didn’t translate to significantly better blood pressure control,” said lead investigator John Dodson, M.D., of NYU Grossman School of Medicine. He noted that electronic bottles only tracked opening, not actual ingestion, and that many participants took multiple medications, while the study monitored only one. “Improving medication adherence is more complex than we thought,” Dodson added.
The study’s limitations include reliance on single medication monitoring and clinic-based blood pressure measurements rather than home monitoring. The results underscore the need for multifaceted approaches to manage hypertension, a key risk factor for heart attack and stroke, as emphasized by the American Heart Association’s high blood pressure resources. The findings were presented as preliminary research at the AHA’s Scientific Sessions 2025, which runs from November 7-10 in New Orleans.
