With high blood pressure (BP) continuing to be a global challenge, effective management must remain a global priority. The results from three late-breaking studies presented at AHA 2025 are shedding light on diverse behavioral, nutritional and family-centered strategies that may help inform larger-scale models that can be implemented worldwide.

In BETTER-BP, researchers explored how behavioral economics can drive effective regulation of BP, offering insights into patient engagement and decision-making. The trial randomly assigned 400 diverse participants from three safety-net clinics in New York City to passive adherence monitoring alone or to passive monitoring plus a mobile health-based incentive lottery administered via SMS messaging for six months. The mean age of participants was 57 years, approximately 60% were women, 61% were Hispanic, 20% were non-Hispanic Black, and more than 70% were on Medicaid or uninsured. All participants had hypertension, were prescribed at least one antihypertensive medication, and self-reported poor medication adherence.

The results, simultaneously published in JACC, found that individuals assigned to the incentive arm were 50% more likely to achieve adequate medication adherence at six months compared with those assigned solely to passive monitoring (71% vs. 34%). However, adherence was similar across both the interventional arm and the monitoring arm during the follow-up period between six and 12 months (31% vs. 26%, respectively).

“Financial incentives clearly worked to change behavior during the study period because people in the rewards group took their medication much more consistently. However, we were surprised that the behavior change didn’t translate to significantly better BP control,” said John A. Dodson, MD, FACC, who presented the findings. “…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.”

Meanwhile, findings from GOFRESH demonstrated the power of nutrition by showing how DASH-patterned groceries can help reduce BP through accessible dietary changes.

Simultaneously published in JAMA, the study randomly assigned 180 Black residents living in urban communities with few grocery stores in Boston, MA, to either 12 weeks of home-delivered, DASH-patterned groceries ordered online each week with dietitian support or three $500 stipends every four weeks intended for self-directed grocery shopping. All participants had a systolic BP of 120 to less than 150 mmHg, a diastolic BP of less than 100 mmHg, and no hypertension treatment.

Overall results showed that individuals receiving the low sodium-DASH groceries saw meaningful decreases in BP at three months, compared with those receiving the monetary stipend. However, study investigators noted that the effects were not maintained once the intervention ended.

“We thought that some of the benefits of the nutrition changes would be maintained after the groceries were discontinued; however, the study did not address other important barriers, such as the cost of nutritious foods or access to grocery stores,” said Stephen P. Juraschek, MD, PhD. “Without addressing these social barriers, it may have been challenging for participants to continue eating healthier foods even after receiving counseling about the impact of diet on high BP and cholesterol.”

In a related editorial comment also published in JAMA, Dariush Mozaffarian, MD, FACC, writes that overall, the trial “advances the field of food is medicine by demonstrating that home-delivered DASH-patterned groceries can modestly reduce [systolic BP], [diastolic BP], and LDL cholesterol among Black adults living in food deserts.” However, he notes that the “intervention’s relatively low-risk population, inclusion of neutral of unhealthy foods, reliance on a low-fat DASH model, and high costs limit its efficacy, scalability, and relevance to practice.” Moving forward, he suggests that future medically tailored grocery programs “should focus on high-risk populations, prioritize foods that are underconsumed and health-promoting, align with current evidence favoring higher-fat DASH- or Mediterranean-style diets, and ensure cost-effectiveness.”

Complementing the GOFRESH and BETTER-BP models, the Healthy Family Program involved a community-based approach, testing a multifaceted family intervention in rural China. Eighty villages participated in the program, with half randomly assigned to receive family-style interventions that included multiple BP lowering strategies such as regular BP monitoring, the use of low-sodium salt substitutes and educational classes on healthy lifestyle habits. Approximately 30-50 families in each village took part in the study and residents aged 40–80 years within participating families were eligible.

Overall results found that participants assigned to the family-based intervention achieved an average reduction of 10 mmHg in systolic BP compared with those who did not participate in the program. Additionally, six months after the program ended, the average systolic BP for people who lived in participating villages remained 3.7 mmHg lower compared with non-participants.

“Most BP programs focus on treatment for people with high BP, whereas our study included the whole family regardless of their BP levels,” said Professor Xin Du, MD, PhD. “In many cultures, families share the responsibility of caring for one another and promoting a healthy lifestyle. In our study, family leaders played a critical role in implementing the program by supporting a healthy diet high in vegetables, fruits and legumes, and low in sodium, fat and sugar. This is crucial for managing BP, as well as for preventing other chronic health conditions, such as obesity and Type 2 diabetes.”

The study had some limitations, including that the six-month intervention period was not long enough to measure reductions in major cardiovascular events. In addition, the program relied on local government for support for recruitment and coordination, which may be necessary for succession implementation in other communities.

Clinical Topics: Prevention

Keywords: AHA Annual Scientific Sessions, AHA25, Secondary Prevention, Care Team