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Behavioral Economics and Medication Adherence for Hypertension: A Randomized Clinical Trial.

John A Dodson¹, Samrachana Adhikari¹, Antoinette M Schoenthaler¹

¹NYU Grossman School of Medicine, New York, New York, USA.

Journal of the American College of Cardiology

|December 11, 2025

Summary

A mobile health (mHealth) intervention using incentive lotteries doubled medication adherence in hypertensive patients but did not significantly lower systolic blood pressure (SBP). This study highlights potential for mHealth in improving adherence among vulnerable populations.

Keywords:

behavioral economics hypertension medication adherence

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Area of Science:

Cardiology
Public Health
Digital Health

Background:

Nonadherence to antihypertensive medications is a significant challenge, particularly in vulnerable populations.
Mobile health (mHealth) interventions show promise for improving medication adherence but require further testing.

Purpose of the Study:

To evaluate the effectiveness of an mHealth-based incentive lottery intervention on medication adherence and systolic blood pressure (SBP) in hypertensive patients.
To assess the impact of the Behavioral Economics Trial To Enhance Regulation of Blood Pressure (BETTER-BP) on adherence and SBP in a safety-net clinic population.

Main Methods:

A randomized trial (BETTER-BP) involving 400 adults with hypertension and poor adherence across 3 safety-net clinics in New York City.
Participants received either an mHealth incentive lottery via SMS or standard care, with passive adherence monitoring over 6 months.
Primary endpoints included changes in SBP and adequate medication adherence (≥80% days adherent) at 6 months.

Main Results:

The intervention group showed significantly higher adequate adherence rates (71% vs. 34%) compared to the control group.
No significant difference in mean SBP reduction was observed between the intervention and control groups at 6 months.
Adherence rates were similar between groups from 6 to 12 months.

Conclusions:

The BETTER-BP mHealth intervention effectively doubled medication adherence in a diverse safety-net population.
Despite improved adherence, the intervention did not lead to a significant reduction in SBP at the 6-month mark.
mHealth interventions hold potential for enhancing medication adherence, but further research is needed to optimize their impact on clinical outcomes like blood pressure.