Missing blood pressure medication may substantially weaken its cardiovascular benefits, according to findings presented at ESC Congress 2026. High blood pressure affects an estimated 1.4 billion adults ages 30 to 79 worldwide, yet approximately half of patients do not follow their prescribed medication instructions.
Qianqian Yang of the University of Oxford and fellow researchers analyzed individual data from 91,339 participants in nine randomized clinical trials. Each compared blood pressure treatment with an alternative approach. Participants taking at least 80% of their assigned medication were classified as having higher adherence; those below that threshold had lower adherence.
Even under structured trial conditions with regular monitoring, adherence deteriorated over time. The proportion meeting the higher-adherence threshold declined from 88% in the first year to 79% in the fifth. Among higher-adherence participants, systolic blood pressure—the upper number in a reading—was 5.2 mmHg lower in the treatment group than in the comparison group. For lower-adherence participants, the difference was 3.0 mmHg.
Higher adherence was also associated with greater cardiovascular protection: the treatment group experienced 11% fewer major events than the comparison group. Outcomes included strokes, heart attacks, ischemic heart disease, and heart failure resulting in hospitalization or death. Among participants with lower adherence, however, the reduction in major events was not statistically significant.
The researchers recommend routine adherence assessments, better patient education, and practical measures to simplify treatment. Options include streamlined medication schedules, combining treatments in a single pill, and longer-acting drugs that may limit the consequences of an occasional missed dose. Health professionals are also encouraged to discuss barriers openly and without judgment.
