Behavioral Economics Trial To Enhance Regulation of Blood Pressure

The Behavioral Economics Trial To Enhance Regulation of Blood Pressure (BETTER-BP) study was a randomized controlled trial for adults with high systolic blood pressure (SBP ≥ 140) who were prescribed at least one antihyperintensive medication, with poor self-reported adherence (<80%). It was designed to investigate whether a mobile health-based incentive lottery intervention would lower systolic blood pressure and improve medication adherence.

A total of 400 participants were recruited from three safety net clinics in New York City between 2020 and 2024 and were randomized in a 2:1 manner (265 intervention; 135 control). Study visits occurred at baseline, 6 months, and 12 months. Adherence was assessed using a wireless electronic monitoring device (EMD) pill bottle provided to study participants; the bottle was connected to a cellular network and registered a signal when opened. Participants in the intervention arm were enrolled in an incentive lottery consisting of a daily random drawing to win either $5 or $50, but were only eligible to receive the prize if their EMD bottle had been opened the day before. Those who won the drawing but did not take their antihypertensive medication received a text message indicating that had they been adherent, they would have received the prize. The incentive lottery ran for 6 months, and adherence was monitored for an additional 6 months.

The primary outcomes were 1) change in SBP from baseline to 6 months and 2) adequate medication adherence (defined as ≥80% adherent) from baseline to 6 months. Secondary outcomes were change in SBP and adequate adherence from 6 to 12 months, with diastolic blood pressure (DBP) measured as an exploratory outcome.