Cash Rewards Double Medication Use But Don't Improve Blood Pressure

A groundbreaking study presented at the American Heart Association's Scientific Sessions 2025 reveals that financial incentives dramatically improved medication adherence among people with high blood pressure, though surprisingly didn't lead to better blood pressure outcomes. The Behavioral Economics Trial To Enhance Regulation of Blood Pressure (BETTER-BP) study, involving 400 adults from New York City community health clinics, found that participants who could win daily cash rewards ranging from $5 to $50 were twice as likely to take their blood pressure medication consistently compared to those not offered incentives. Using electronic pill bottles to track medication use rather than relying on self-reporting, researchers discovered that 71% of the rewards group opened their medication regularly during the six-month intervention period, compared to just 34% in the control group.

Despite this significant improvement in medication adherence behavior, both groups experienced similar blood pressure reductions—approximately 6-7 mm Hg systolic—raising important questions about the relationship between medication-taking behavior and actual health outcomes. The study, led by Dr. John Dodson of NYU Grossman School of Medicine, also revealed that when the rewards program ended after six months, participants quickly reverted to their previous medication-taking habits, suggesting that financial incentives create temporary behavior changes rather than lasting habits. The research focused on underserved populations, with over 70% of participants covered by Medicaid or uninsured, groups that traditionally face higher rates of uncontrolled blood pressure and medication non-adherence issues.

The findings highlight the complexity of managing high blood pressure and the limitations of simple behavioral interventions. Researchers noted several important limitations, including that electronic pill bottles only tracked bottle openings rather than actual medication consumption, and participants may have been taking multiple blood pressure medications beyond the one being monitored. The study's publication in the peer-reviewed journal JACC adds credibility to these findings, which challenge conventional assumptions about medication adherence and cardiovascular outcomes. The research underscores the need for more comprehensive approaches to managing chronic conditions like high blood pressure, particularly among vulnerable populations who face multiple barriers to consistent healthcare.