Missing blood pressure medication may reduce protection against heart attacks and strokes. Learn what a study of 91,339 people found about medication adherence.
Missing prescribed blood pressure medication could weaken protection against heart attacks, strokes and other serious cardiovascular problems, according to a major analysis involving more than 91,000 people. The findings suggest that missing blood pressure medication regularly may reduce the benefits of treatment, highlighting the importance of following a prescribed healthcare plan.
The research, presented at ESC Congress 2026, examined data from nine clinical trials. Researchers found that participants who consistently followed their treatment experienced an 11% reduction in major cardiovascular events in the treatment group compared with the respective comparison groups. However, among participants who took their medication less consistently, the analysis did not identify a statistically significant reduction in these events.
The findings are particularly relevant because high blood pressure, also known as hypertension, affects an estimated 1.4 billion adults worldwide. Consistent treatment and regular medical follow-ups remain important parts of managing the condition.
Study Analyses Data From More Than 91,000 People
Researchers analysed individual patient data from nine clinical trials involving a total of 91,339 participants. The trials compared blood pressure-lowering treatments with placebos or less intensive treatment approaches.
For the analysis, participants were divided into two groups based on how regularly they took their assigned medication. Those who took at least 80% of their prescribed doses were classified as having higher adherence, while those who took less than 80% were placed in the lower-adherence group.
The researchers also observed that medication adherence declined over time. The proportion of participants meeting the higher-adherence threshold dropped from 88% during the first year to 79% by the fifth year.
This decline occurred even though participants were being monitored in the structured environment of clinical trials. The results indicate that maintaining a regular medication routine can be challenging over extended periods.
Missing Blood Pressure Medication May Weaken Treatment Benefits
The analysis found a difference in blood pressure control between participants who followed their treatment consistently and those who missed more doses.
Among participants with higher adherence, systolic blood pressure was 5.2 mmHg lower in the treatment group than in the comparison group. For those with lower adherence, the difference was smaller, at 3.0 mmHg.
Researchers also assessed major cardiovascular outcomes, including heart attacks, strokes, ischaemic heart disease and heart failure resulting in hospitalisation or death.
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The treatment group among participants with higher medication adherence experienced an 11% lower incidence of major cardiovascular events than the comparison group. In contrast, the analysis did not find a statistically significant reduction among participants with lower adherence.
These findings suggest that missing blood pressure medication can limit the cardiovascular protection associated with treatment. However, the results do not mean that every missed dose will cause a heart attack or stroke. Rather, they highlight the importance of taking medication consistently over time.
Experts Call for Better Medication Adherence
Miss Qianqian Yang from the University of Oxford, UK, who presented the findings, explained that earlier evidence linking poor adherence to worse health outcomes largely came from observational studies. The research team used data from randomised clinical trials to investigate how adherence influenced the benefits of blood pressure treatment.
The researchers said their findings support the need for routine assessment of medication adherence as part of hypertension care. Healthcare professionals can help patients identify obstacles that make it difficult to take medicines as prescribed.
Professor Felix Mahfoud, Chair of the ESC Communication Committee, also highlighted the need for healthcare providers to address missed doses when treating uncontrolled hypertension. He emphasised open, non-judgmental conversations between patients and healthcare professionals to understand the reasons behind inconsistent medication use.
How Patients Can Improve Their Medication Routine
Researchers suggested several practical approaches that may help patients follow their prescribed treatment more consistently. These include simplifying dosing schedules, using combination pills containing multiple medicines when appropriate, and considering longer-acting medications under medical supervision.
Patients may also find it helpful to use reminders, pill organisers or a daily medication schedule. Anyone experiencing side effects, financial difficulties or problems with a complex prescription should discuss these concerns with their healthcare professional.
People should not stop, change or double a prescribed dose without medical advice. If a dose is missed, they should follow the instructions provided for their particular medicine or consult a pharmacist or doctor.
Overall, the findings reinforce that missing blood pressure medication regularly may reduce the benefits of hypertension treatment. Taking prescribed medicines as directed, attending follow-up appointments and discussing treatment difficulties with a healthcare professional can help support better blood pressure management and long-term cardiovascular health.
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