Here’s a startling fact: despite high blood pressure being one of the most preventable risk factors for heart attacks and strokes, millions of people still struggle to manage it effectively. But what if a simple financial incentive could double the likelihood of patients taking their medication regularly? A groundbreaking study has explored this very question, and the results are both intriguing and surprisingly complex. Let’s dive into what they found—and why it matters more than you might think.
A recent study, known as the Behavioral Economics Trial to Enhance Regulation of Blood Pressure (BETTER-BP), revealed that individuals with high blood pressure were twice as likely to adhere to their medication regimen when offered daily chances to win cash rewards. However—and this is the part most people miss—despite this significant improvement in adherence, their blood pressure measurements did not show better results compared to those who weren’t offered financial incentives. But here’s where it gets controversial: does this mean the rewards were ineffective, or is there something deeper at play?
The study, led by Dr. John A. Dodson, director of NYU Langone’s Geriatric Cardiology Program, was presented at the American Heart Association’s Scientific Sessions 2025 in New Orleans and published in the Journal of the American College of Cardiology (JACC). Dr. Dodson emphasized, ‘We’re always searching for innovative ways to improve medication adherence, especially among high-risk, low-income populations. High blood pressure is a major concern, and consistent medication use is key to controlling it.’
BETTER-BP involved 400 adults from three community health clinics in New York City, primarily serving Medicaid recipients and uninsured patients—groups disproportionately affected by uncontrolled blood pressure. Participants were randomly divided into two groups: one with the opportunity to win cash rewards for taking their medication and a control group without incentives. To ensure accuracy, the study used electronic pill bottles to track medication use, rather than relying on self-reports.
Here’s how it worked: participants in the rewards group could win cash prizes ranging from $5 to $50 daily, but only if they opened their pill bottle the previous day. They received text messages notifying them of their winnings (or lack thereof). If they missed a dose, the study app sent a reminder, highlighting the missed reward opportunity. The study lasted 12 months, with rewards offered for the first six months and then discontinued to observe if the behavior persisted.
The findings were eye-opening:
- Financial incentives doubled adherence rates. Approximately 71% of participants in the rewards group took their medication regularly (at least 80% of the time), compared to just 34% in the control group.
- Blood pressure improvements were similar across both groups. After six months, systolic blood pressure dropped by 6.7 mm Hg in the rewards group and 5.8 mm Hg in the control group—a surprisingly small difference.
- Behavior changes didn’t last. Once the rewards stopped, adherence rates plummeted, returning to pre-study levels.
Dr. Dodson noted, ‘While financial incentives clearly boosted adherence during the study, we were surprised this didn’t translate into significantly better blood pressure control. It raises questions: Did participants open the bottles without taking the medication? Or were other factors, like lifestyle or multiple medications, at play? And why did adherence drop so sharply once the rewards ended? This highlights the complexity of behavior change and the need for long-term solutions.’
But here’s the controversial part: If financial incentives can double adherence but not improve health outcomes, are they worth implementing? Or do we need to rethink how we approach patient motivation altogether? What do you think? Let’s spark a discussion in the comments.
The study had limitations, including the inability of electronic pill bottles to confirm actual medication ingestion and the focus on only one blood pressure medication per participant, despite many taking multiple drugs. Blood pressure was also measured in clinic at just three points, rather than through more frequent home monitoring.
Participants had a median age of 57, with 60.5% being women. By race and ethnicity, 61.5% identified as Hispanic, 20.3% as Black, 3.3% as non-Hispanic White, 2.8% as Asian, and 12.3% as another group. Over 50% had obesity, and 46.5% had type 2 diabetes. More than 70% were covered by Medicaid or uninsured, underscoring the study’s focus on high-risk, low-income populations.
Supported by the National Heart, Lung, and Blood Institute and the National Institutes of Health, BETTER-BP sheds light on the challenges of improving health outcomes in underserved communities. But it also leaves us with a critical question: How can we sustain healthy habits without relying on external rewards? Share your thoughts below—this conversation is far from over.
