People with high blood pressure were twice as likely to take their blood pressure medication regularly when offered daily chances to win cash rewards, yet they did not achieve better blood pressure measurements compared to people who were not offered financial rewards, according to a study reported at  the American Heart Association (AHA)’s Scientific Sessions 2025 and published simultaneously in an AHA journal.

The study included 400 adults with high blood pressure who received care at three community health clinics in New York City, and were more likely to have higher rates of uncontrolled blood pressure and are likely to take their blood pressure medication consistently.

The participants were randomly assigned to a group eligible to win cash rewards for taking their blood pressure medication or a control group that was not offered the chance to win cash. All reported that they did not take their blood pressure medication as prescribed before the study began.

Electronic pill bottles were used to monitor how often participants opened their medication bottles during the study period, as a measure of daily medication use. Participants were monitored for six months of the rewards program followed by six months of additional monitoring without rewards to look for changes in medication-taking habits after the financial incentives ended.

Key findings include:

• Financial incentives doubled consistent medication use, with 71% of participants in the rewards group opening their medication regularly compared to 34% of people in the control group.
• People in both groups experienced similar reductions in systolic blood pressure at six months.
• After the cash rewards ended, the study found that those participants reverted to their previous behavior of not consistently taking their medication as prescribed.

“We were surprised that the behavior change didn’t translate to significantly better blood pressure control,” said  principal investigator John Dodson, MD of NYU Grossman School of Medicine in New York City. . “It is unclear if there was no change because they opened the bottles but didn’t take the medication tracked, or if a different medication or lifestyle behavior not tracked in the study impacted their blood pressure.”

“We were also surprised that people did not keep taking their medication as prescribed after the rewards program ended. 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,” he added.

To read the abstract of the study, published in the Journal of the American College of Cardiology, click here