Patients with high blood pressure were twice as likely to take their prescribed medication when offered daily chances to win cash rewards, yet they achieved similar blood pressure reductions compared to those not receiving financial incentives, according to research presented at the American Heart Association's Scientific Sessions 2025. The Behavioral Economics Trial To Enhance Regulation of Blood Pressure (BETTER-BP) study followed 400 adults with high blood pressure who received care at three community health clinics in New York City, primarily serving Medicaid recipients and uninsured individuals.
The study's findings challenge conventional assumptions about medication adherence and health outcomes. During the six-month rewards program, 71% of participants in the incentives group consistently opened their medication bottles compared to only 34% in the control group. However, both groups experienced nearly identical blood pressure improvements - a 6.7 mm Hg reduction in the rewards group versus 5.8 mm Hg in the control group. This discrepancy between behavior change and health outcomes raises important questions about the relationship between medication adherence and blood pressure control.
According to principal investigator Dr. John Dodson, associate professor at NYU Grossman School of Medicine, "Financial incentives clearly worked to change behavior during the study period because people in the rewards group took their medication much more consistently. However, we were surprised that the behavior change didn't translate to significantly better blood pressure control." The research suggests that simply increasing medication adherence through financial incentives may not address the complex factors influencing blood pressure management.
The study's implications extend beyond hypertension treatment to broader questions about sustainable behavior change in chronic disease management. When the cash rewards ended after six months, participants quickly reverted to their previous medication-taking habits. This finding underscores the temporary nature of incentive-driven behavior change and highlights the need for more comprehensive approaches to long-term health management. The research appears in the peer-reviewed journal JACC.
Methodological considerations may partly explain the unexpected results. Researchers used electronic pill bottles that recorded when bottles were opened but couldn't verify whether medication was actually consumed. Additionally, the study monitored only one blood pressure medication per participant, though many patients take multiple medications. Blood pressure measurements were taken at standardized office visits rather than through continuous home monitoring, which might have provided different insights.
The study population consisted primarily of vulnerable patients, with more than 70% covered by Medicaid or uninsured. Participants had a median age of 57 years, 60.5% were women, and 61.5% identified as Hispanic. Many had additional health conditions, with 54.5% having obesity and 46.5% diagnosed with Type 2 diabetes. These demographic characteristics highlight the importance of developing effective interventions for populations that traditionally face barriers to consistent healthcare.
This research matters because it challenges healthcare systems to reconsider how they approach medication adherence programs. While financial incentives can temporarily improve medication-taking behavior, they may not address the underlying factors affecting blood pressure control. The findings suggest that more holistic approaches combining medication management with lifestyle interventions and ongoing support may be necessary for meaningful health improvements. The study also emphasizes the need for sustainable solutions rather than temporary fixes in chronic disease management.
The American Heart Association's 2025 High Blood Pressure Guideline emphasizes that uncontrolled hypertension increases the risk of heart attack and stroke. The BETTER-BP study contributes important evidence about the limitations of financial incentives in achieving lasting health improvements, suggesting that healthcare providers and policymakers need to develop more comprehensive strategies for managing chronic conditions.
