Winning cash for taking blood pressure meds increases compliance
Financial incentives appear to double consistent hypertension medication use, according to a study led by NYU Langone Health and presented as a late-breaker at the American Heart Association (AHA) 2025 Scientific Sessions.
“Financial incentives clearly worked during the study—people in the rewards group took their medication much more consistently,” said John A. Dodson, MD, MPH, principal investigator and lead author of the study in a statement. Dodson is the director of NYU Langone’s Geriatric Cardiology Program and an associate professor in the Department of Medicine’s Leon H. Charney Division of Cardiology at NYU Langone Health.
Preliminary results from the Behavioral Economics Trial to Enhance Regulation of Blood Pressure (BETTER-BP) study included 400 patients with hypertension from three community health clinics in New York City that primarily serve patients on Medicaid or who do not have health insurance. They were prescribed at least one blood pressure drug and had a systolic pressure above 140 mm Hg over the past year. Patients were randomly split into two groups, with two-thirds entered into a program in which they could win cash rewards for taking their blood pressure medication. The rest of the patients were a control group that did not receive any incentives. All patients in the study reported having issues with medication compliance.
The research team used electronic pill bottles that recorded each time they were opened to track usage over the six-month study. Patients also had a baseline blood pressure recorded, with the average systolic blood pressure being 139 mm Hg.
Researchers found that about 71% of patients in the rewards group opened their blood pressure medication on 80% of days. But the control group only opened the bottles on about 34% of days. Interestingly, both groups saw similar drops in blood pressure, with average systolic pressure falling by 6.7 mm Hg in the rewards group and 5.8 mm Hg in the control group.
“We were surprised that this didn’t lead to significantly better blood pressure control," Dodson said. "It’s unclear whether participants opened the bottles without taking the medication, or if other untracked factors, like different medications or lifestyle behavior, affected their blood pressure."
Also, once the rewards ended, so did improvements in blood pressure, as medication habits returned to pre-study noncompliance levels.
Dodson said the team was also surprised that adherence to medication dropped when the rewards ended. He said this shows how complex behavior change really is.
BETTER-BP was supported by a grant from the National Heart, Lung, and Blood Institute and the National Institutes of Health.
The study was also simultaneously published in the Journal of the American College of Cardiology (JACC).
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]