A recent study found that offering daily chances to win cash rewards doubled the rate at which people with high blood pressure took their medication, but did not result in greater reductions in blood pressure compared to those who received no financial incentives.
The research, known as the Behavioral Economics Trial to Enhance Regulation of Blood Pressure (BETTER-BP), was presented at the American Heart Association’s Scientific Sessions 2025 and published in the Journal of the American College of Cardiology. The trial involved 400 adults from three community health clinics in New York City, serving primarily Medicaid recipients and uninsured patients—groups that often face challenges managing blood pressure.
Participants were randomly assigned either to a group eligible for daily cash prizes if they took their medication or to a control group without such incentives. Electronic pill bottles recorded when participants opened them. At baseline, average systolic blood pressure was 139 mm Hg; normal is considered below 120 mm Hg according to current guidelines.
For six months, those in the incentive group could win between $5 and $50 each day if they took their medication as prescribed. They received text messages about winnings or reminders if they missed doses. After six months, incentives stopped but monitoring continued for another six months.
“Financial incentives clearly worked during the study—people in the rewards group took their medication much more consistently,” said Dr. John A. Dodson, principal investigator and director of NYU Langone’s Geriatric Cardiology Program. “But we were surprised that this didn’t lead to significantly better blood pressure control. 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. We were also surprised that adherence dropped once the rewards ended. This shows how complex behavior changes really are. There’s still a lot we need to understand about what helps people stick with healthy habits long term.”
Researchers noted several limitations: electronic pill bottles could only track openings—not actual ingestion—and only one medication per participant was monitored despite many being on multiple drugs for hypertension management. Blood pressure readings were taken at three clinic visits over 12 months rather than through frequent home monitoring.
The BETTER-BP study was supported by grants from the National Heart, Lung, and Blood Institute and National Institutes of Health.
NYU Langone Heart is recognized nationally for its cardiology services and heart surgery outcomes, including high success rates treating various heart conditions across its network in New York City and beyond (https://nyulangone.org/locations/nyu-langone-heart). NYU Langone Health operates a large integrated system with seven inpatient locations and more than 320 outpatient sites in New York and Florida (https://nyulangone.org/about), maintaining some of the lowest mortality rates nationwide according to Vizient rankings.
