AHA Scientific Sessions 2025 — Late-breaker host Dr Harriette Van Spall (McMaster University, Hamilton, CA) is joined by BETTER-BP Principal Investigator Dr John Dodson (NYU Langone Health, New York, US) to present the findings of this AHA late-breaking trial (NCT04114669).

The BETTER-BP (Behavioral Economics Trial to Enhance Regulation of Blood Pressure) is a phase II pragmatic randomized clinical trial testing whether lottery-based financial incentives can improve blood pressure control among patients with poor adherence to antihypertensive therapy. Conducted within NYC Health + Hospitals and NYU Langone Family Health Centers, the study enrolled 401 adults with hypertension, randomized 2:1 to a regret lottery intervention (n≈267) versus usual care control (n≈134).

The intervention, delivered via smartphone through the Way to Health platform, combined daily medication adherence monitoring with a lottery-based incentive design incorporating regret feedback. Participants were followed for 12 months to evaluate systolic blood pressure reduction and medication adherence as primary outcomes, with secondary measures including motivation, self-efficacy, comorbidity burden, depression, and health status.

Investigators found that behavioral economics-based lottery successfully doubled the rate of adequate antihypertensive medication adherence from baseline to 6 months in a safety-net population. However, this improved adherence did not lead to a reduction in systolic blood pressure compared with the control group at 6 months, and adherence was not sustained once the lottery incentive was remove

For more content from AHA 2025 head to the Late-breaking Science Video Collection.

Editor: Mirjam Boros.
Videographer: Tom Green and Dan Brent.

Support: This is an independent video produced by Radcliffe Cardiology.