Financial Incentives Boost Medication Adherence but Fail to Improve Blood Pressure Outcomes in Study

A study of 400 adults with high blood pressure revealed that participants were twice as likely to take their medication when offered daily chances to win cash rewards, yet they achieved similar blood pressure reductions compared to people not offered financial incentives. The Behavioral Economics Trial To Enhance Regulation of Blood Pressure (BETTER-BP) study, presented at the American Heart Association's Scientific Sessions 2025 and simultaneously published in the peer-reviewed journal JACC, demonstrated that financial incentives successfully changed behavior during the intervention period but failed to produce lasting benefits.

The research involved adults receiving care at three community health clinics in New York City, primarily serving Medicaid recipients and uninsured individuals who often struggle with medication adherence. Participants were randomly assigned to either a rewards group eligible for daily cash drawings or a control group without incentives. Researchers used electronic pill bottles to monitor medication bottle openings as a measure of daily medication use, rather than relying on self-reported data.

During the six-month rewards period, 71% of participants in the incentives group consistently opened their medication bottles compared to only 34% in the control group. However, both groups experienced similar systolic blood pressure reductions - 6.7 mm Hg in the rewards group versus 5.8 mm Hg in the control group. More concerning, when the cash rewards ended after six months, participants in the incentives group reverted to their previous patterns of inconsistent medication use.

"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," said Dr. John Dodson, principal investigator of the study and associate professor at NYU Grossman School of Medicine. The study's findings suggest that improving medication adherence involves more complex factors than previously understood, particularly for achieving long-term behavior changes.

The research had several limitations, including that electronic pill bottles only monitored whether bottles were opened, not whether medication was actually taken. Additionally, researchers monitored only one blood pressure medication per participant, though many were prescribed multiple medications. The study used standardized office blood pressure measurements rather than more frequent home monitoring, which might have yielded different results. More information about high blood pressure management is available at https://www.heart.org/en/health-topics/high-blood-pressure.

Study participants represented a diverse population with a median age of 57 years, 60.5% women, and significant representation of Hispanic (61.5%) and Black (20.3%) individuals. More than 70% were covered by Medicaid or had no health insurance, and many had additional health conditions including obesity (54.5%) and Type 2 diabetes (46.5%). The findings highlight the challenges of managing chronic conditions in populations facing socioeconomic barriers to consistent healthcare, suggesting that financial incentives alone may be insufficient for achieving meaningful long-term health improvements in vulnerable populations.