Financial Incentives Double Blood Pressure Medication Use But Fail to Improve Health Outcomes
A new study reveals that while daily cash rewards doubled medication adherence among high blood pressure patients, the improved compliance did not translate to better blood pressure control, highlighting the complexity of long-term behavior change.
A study of 400 adults with high blood pressure found that participants were twice as likely to take their blood pressure medication when offered daily cash rewards, yet achieved similar blood pressure reductions compared to those not receiving 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, examined medication adherence among patients receiving care at three community health clinics in New York City.
Participants in the rewards group demonstrated 71% consistent medication use compared to 34% in the control group during the six-month intervention period. However, both groups showed comparable blood pressure improvements, with the rewards group experiencing an average 6.7 mm Hg reduction in systolic blood pressure versus 5.8 mm Hg in the control group. The findings challenge assumptions about the relationship between medication adherence and clinical outcomes.
"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 used electronic pill bottles to monitor medication bottle openings rather than relying on self-reported data.
The research involved primarily low-income participants, with more than 70% covered by Medicaid or uninsured. These populations typically face higher rates of uncontrolled blood pressure and lower medication adherence. Not taking blood pressure medication as directed can increase the risk of heart attack and stroke, according to American Heart Association guidelines available at https://www.heart.org/en/health-topics/high-blood-pressure.
Perhaps most significantly, when the rewards program ended after six months, participants reverted to their previous medication-taking habits. "This shows that improving medication adherence is more complex than we thought. There are still many unknown factors we need to understand in order to help people adopt long-term behavior changes," Dodson added. The study monitored participants for an additional six months following the intervention period.
The research had several limitations, including that electronic pill bottles only tracked bottle openings rather than actual medication consumption. Researchers monitored only one blood pressure medication per participant, though many were prescribed multiple medications. The study also relied on standardized office blood pressure measurements rather than more frequent home monitoring, which might have yielded different results. Additional information about blood pressure management is available at https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure.
The findings suggest that while financial incentives can effectively modify short-term behavior, they may not address the underlying barriers to consistent medication use or produce corresponding health improvements. This has important implications for healthcare systems and insurers considering incentive-based programs to improve chronic disease management, particularly among vulnerable populations who face multiple barriers to consistent care.