# BETTER-BP (Behavioral Economics Trial To Enhance Regulation of Blood Pressure)

> **NIH NIH R01** · NEW YORK UNIVERSITY SCHOOL OF MEDICINE · 2020 · $756,017

## Abstract

PROJECT SUMMARY
Adherence to antihypertensive medications remains unacceptably low despite decades of research. This is
especially true in vulnerable populations (socioeconomically disadvantaged and/or minority) who
simultaneously experience the highest rates of adverse hypertension-related sequelae (e.g. myocardial
infarction, stroke), and have the lowest levels of adherence. Studies to date targeted at improving adherence,
such as patient education and counseling, have yielded some success but are often resource-intensive and not
scalable across institutions. Behavioral economic approaches have recently been developed to enhance
medication adherence; these strategies aim to leverage innately human tendencies (such as overweighting of
immediate benefits) in order to improve health behaviors. To date, several behavioral economic-based studies
using a lottery incentive program (“regret lottery”) approach, whereby participants are encouraged to undertake
healthy behaviors through the desire to avoid regret over losing financial incentives, have been promising.
However, whether these incentives translate to sustainable behavior change in vulnerable populations is
unclear. In this context we propose BETTER-BP (Behavioral Economics Trial To Enhance Regulation of Blood
Pressure), a pragmatic randomized trial within the New York City Health and Hospitals (NYC-H+H) system,
which is the largest public hospital system in the U.S. and serves a diverse and disadvantaged population. Our
trial will recruit from 3 NYC-H+H ambulatory clinics, and will use a lottery incentive program to promote
adherence to antihypertensive medication that will be delivered via smartphone for 6 months. Participants will
be followed for a total of 12 months to examine durable effects. We will randomize 435 patients with
hypertension determined to have poor adherence (<80% adherence with antihypertensive medication), in a 2:1
(intervention:control) ratio. In Aim 1 we will evaluate the effects of the incentive lottery on ambulatory systolic
blood pressure (SBP) and adherence (good adherence defined by ≥80% days adherent) between intervention
and control arms at 6 months. We hypothesize that the incentive lottery will reduce SBP by ≥10 mmHg
compared with control, and that more participants receiving the lottery will be adherent. In Aim 2 we will
examine durable effects of the lottery on SBP and adherence at 12 months. In Aim 3, we will analyze
trajectories of adherence among participants assigned to the intervention group, as well as predictors of
category membership. The PI for this project (Dr. Dodson) is a cardiologist and Early Stage Investigator with
experience in cardiovascular epidemiology and clinical trials. Co-I’s are Dr. Troxel, a biostatistician and expert
in behavioral economic clinical trials, and Dr. Schoenthaler, a behavioral scientist with expertise in adherence
and patient engagement. The results could lead to sustainable and scalable strategies to improve
antihyper...

## Key facts

- **NIH application ID:** 10019587
- **Project number:** 5R01HL148275-02
- **Recipient organization:** NEW YORK UNIVERSITY SCHOOL OF MEDICINE
- **Principal Investigator:** John A Dodson
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $756,017
- **Award type:** 5
- **Project period:** 2019-09-17 → 2024-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10019587

## Citation

> US National Institutes of Health, RePORTER application 10019587, BETTER-BP (Behavioral Economics Trial To Enhance Regulation of Blood Pressure) (5R01HL148275-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10019587. Licensed CC0.

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