Missing prescribed blood pressure medication could significantly reduce its protective benefits against heart attacks, strokes and other serious cardiovascular complications, according to an analysis of more than 91,000 people. Researchers found that participants who followed their treatment consistently experienced an 11% reduction in major cardiovascular events, while those who took fewer doses saw little or no statistically significant benefit.
The findings, presented at ESC Congress 2026 and reported by ScienceDaily, shows the importance of taking hypertension medication as prescribed. With high blood pressure affecting an estimated 1.4 billion adults worldwide, inconsistent medication use remains a major concern.
"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 have come from observational studies and could be confounded by other factors. We undertook an analysis of randomised trial data to assess the true impact of adherence on the benefits of antihypertensive treatment," added Miss Qianqian Yang, as quoted by the ScienceDaily website.
ALSO READ: Blood Cancer Treatment: Bharat Biotech Partners With VeGen Bio, Targets 2028 Launch
Study Of 91,339 Participants Examines Missed Doses
Researchers analysed individual patient data from nine clinical trials involving 91,339 participants. Each trial compared a blood pressure treatment with either a placebo or a less intensive treatment approach.
Participants were classified according to how consistently they followed their prescribed treatment. Those who took at least 80% of their assigned medication were placed in the higher-adherence group, while those who took less than 80% were categorised as having lower adherence.
However, consistency declined over time, even under the regular monitoring provided by clinical trials. The proportion of participants meeting the higher-adherence threshold fell from 88% in the first year to 79% by the fifth year.
"A decline in adherence over time was apparent, even in the structured setting of trials," noted Miss Yang.
ALSO READ: Childhood Cancer Survival In India Could Improve Over Next Five Years, Says AIIMS Delhi Professor
Skipping Blood Pressure Pills May Weaken Cardiovascular Protection
The researchers also found differences in blood pressure control between the two groups. Among participants with higher adherence, systolic blood pressure was 5.2 mmHg lower in the treatment group than in the comparator group. Among those with lower adherence, the difference was just 3.0 mmHg.
The team then assessed major cardiovascular outcomes, including strokes, heart attacks, ischaemic heart disease and heart failure resulting in hospitalisation or death.
Participants who followed their treatment more consistently experienced an 11% lower incidence of major cardiovascular events in the treatment group than in the comparator group. Among those with lower adherence, however, the analysis found no statistically significant reduction.
"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, as quoted by the website.
Researchers called for more routine checks on medication adherence, better patient education and practical measures to make prescribed treatment easier to follow. Potential approaches include simplifying dosing schedules, combining multiple medicines into a single pill and using longer-acting medications where appropriate.
Professor Felix Mahfoud, Chair of the ESC Communication Committee, also stressed the need to address missed doses as a factor in poorly controlled hypertension.
"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," added Mahfoud as quoted by ScienceDaily.
(With inputs from ANI)