Inconsistent use of blood pressure medication may substantially diminish its protection against serious cardiovascular events, according to findings presented at ESC Congress 2026. High blood pressure affects an estimated 1.4 billion adults aged 30–79 worldwide, while approximately half of patients do not take their prescribed medication as directed.
Researchers analysed individual data from 91,339 participants across nine randomised clinical trials. Each trial compared a blood pressure intervention with either a placebo or a less intensive treatment regimen. Presenter Qianqian Yang, from the University of Oxford, explained that the analysis sought to clarify the impact of adherence beyond earlier observational findings, which could have been influenced by other factors.
Participants taking at least 80% of their assigned medication were classified as having higher adherence; those below this threshold had lower adherence. Despite structured monitoring, adherence declined over time: 88% met the threshold during the first year, compared with 79% in the fifth year.
Higher adherence was associated with greater blood pressure reductions. Within this category, the intervention group experienced 11% fewer major cardiovascular events than the comparator group, whereas no statistically significant reduction emerged among participants with lower adherence. The outcomes examined included strokes, heart attacks, ischaemic heart disease, and heart failure resulting in hospitalisation or death.
The researchers advocate routine adherence assessments, improved patient education and practical measures to simplify treatment. Options include less complicated schedules, combining several treatments in one pill, and prescribing longer-acting medication to limit the consequences of occasional missed doses. Professor Felix Mahfoud, Chair of the ESC Communication Committee, also emphasised open, non-judgemental discussions about barriers to taking medication.
