Table of Contents

• Cash Rewards Boost Blood Pressure Medication Adherence, But Don’t Lower Readings
  • At a Glance
  • The Challenge of Blood Pressure Control
  • How the Study Worked

People with high blood pressure were twice as likely to take thier blood pressure medications regularly when offered daily chances to earn cash rewards, but they didn’t get better blood pressure readings than people who didn’t receive financial rewards, a new study finds.

Preliminary results from the Behavioral Economics trial to Improve Blood Pressure Regulation (BETTER-BP) were presented in a late-breaking scientific session at the American Heart Association 2025 Scientific Sessions in New Orleans on November 9 and simultaneously published as a full manuscript in the Journal of the American College of Cardiology (JACC).

“We are always looking for ways to improve medication adherence in our patients with heart disease, and high blood pressure is one of the most preventable risk factors,” said John A. Dodson, MD, MPH, principal investigator and senior author of the study. Dr. Dodson is Director of the Geriatric Cardiology Program at NYU Langone and Associate Professor in the Leon H. Charney Division of Cardiology in the Department of Medicine at NYU Langone Health.

The Challenge of Blood Pressure Control

BETTER-BP included 400 adults from three New York community health clinics. These clinics primarily serve patients on Medicaid and those without health insurance, groups who often struggle with uncontrolled blood pressure and have difficulty following prescribed treatments. High blood pressure is a major risk factor for heart attacks and strokes, and it can frequently enough be controlled with regular medication.

Participants were randomly divided into two groups. About two-thirds participated in a program in which they could earn cash rewards for taking their blood pressure medications, and the remaining third were in a control group that did not receive this incentive. Before the study began, everyone reported that they did not consistently take their medications as prescribed.

How the Study Worked

to track how frequently enough participants took their pills, Dr. Dodson and the research team used electronic pill bottles that recorded each time they were opened, rather than relying on participants to self-report. At the start of the study, the average systolic blood pressure (the highest number in a blood pressure measurement) was 139 mm Hg. For reference, the American heart Association’s 2025 guideline states that a normal systolic blood pressure is less than 120 mm Hg.

Participants in the rewards group were entered into a daily drawing to win cash prizes ranging from $5 to $50, but only if they opened their pill bottle the day before, demonstrating that they were taking their blood pressure medication. Every day they received a text message indicating whether they had won money. If they missed a dose, the study app sent them a reminder that they could have been eligible for a reward if they had taken their medication. Members of the control group did not receive text messages or have the chance to win money.

The study lasted 12 months: 6 months with rewards, followed by 6 months without rewards.