Missing doses of blood pressure medication could significantly reduce its ability to protect against heart attacks, strokes, and other serious cardiovascular problems, according to findings presented at ESC Congress 2026.
An estimated 1.4 billion adults worldwide between the ages of 30 and 79 have high blood pressure (hypertension), a major contributor to illness and death. Although medications that lower blood pressure are proven to reduce the risk of cardiovascular complications, approximately half of patients do not take their prescriptions as directed.
“We have evidence that poor adherence to antihypertensive medication is associated with worse outcomes,” explained presenter, Miss Qianqian Yang from the University of Oxford, UK. “However, previous data has come from observational studies and could be confounded by other factors. We undertook an analysis of randomized trial data to assess the true impact of adherence on the benefits of antihypertensive treatment.”
Major Study Examines the Impact of Missed Blood Pressure Medication
To better understand how consistently taking medication affects its benefits, researchers analyzed individual patient data from 91,339 participants across nine clinical trials. Each trial compared a blood pressure treatment (intervention group) with an alternative approach (comparator group: either placebo or a less-intensive regimen).
The researchers divided participants into two categories based on how closely they followed their prescribed treatment. Those who took at least 80% of their assigned medication were considered to have higher adherence, while those who took less than 80% were placed in the lower adherence group.
Even with the regular monitoring and structured conditions of clinical trials, patients became less consistent about taking their medication as time passed.
“A decline in adherence over time was apparent, even in the structured setting of trials,” noted Miss Yang. Overall, 88% of participants met the higher adherence threshold during the first year, but that figure had dropped to just 79% by the fifth year.
Skipping Blood Pressure Pills Reduces Treatment Benefits
The difference in medication adherence was reflected in how much patients’ blood pressure improved.
Among participants with higher adherence, systolic blood pressure, the top number in a blood pressure reading, was 5.2 mmHg lower in the intervention group than in the comparator group. For those with lower adherence, the difference was considerably smaller at just 3.0 mmHg.
Researchers then examined whether these differences translated into protection against major cardiovascular problems. The outcomes included strokes, heart attacks (myocardial infarction), ischemic heart disease, and heart failure that resulted in hospitalization or death.
The findings revealed a striking contrast. Among patients who consistently followed their treatment plans, the intervention group experienced an 11% lower incidence of major cardiovascular events compared with the comparator group. However, among patients with lower adherence, there was no statistically significant reduction in these events.
“Notably, our results reinforce the saying that ‘drugs don’t work in patients who don’t take them.’ Patients with lower adherence derived little or no cardiovascular benefit, whereas those with higher adherence had greater reductions in blood pressure and prevention of cardiovascular events,” said Miss Yang.
Helping Patients Get Lifesaving Heart Protection
The researchers believe that helping people take their medication consistently should become a greater priority in the treatment of high blood pressure. They recommend more routine assessments of medication adherence, along with better patient education and practical strategies to make treatment easier to follow.
Possible approaches include simplifying medication schedules, combining multiple treatments into a single pill, and prescribing longer-acting drugs that can help limit the consequences of an occasional missed dose.
Professor Felix Mahfoud, Chair of the ESC Communication Committee, emphasized that missed medication has received too little attention as a contributor to poorly controlled blood pressure.
“For years, we have neglected non-adherence to medication as a cause for uncontrolled hypertension. Assessment of adherence should become a routine part of hypertension care so patients do not miss out on life-saving benefits. As healthcare providers, we are here to have open, non-judgmental conversations with our patients about any barriers they may have to taking medication, to help improve adherence.”