Missed doses sharply reduce the benefits of blood pressure medication
An analysis presented at ESC Congress 2026 suggests that blood pressure drugs deliver far less cardiovascular protection when patients regularly miss doses. Researchers examined individual data from 91,339 participants in nine randomized trials comparing antihypertensive treatment with placebo or a less intensive regimen. Participants who took at least 80% of their assigned medication were classed as having higher adherence.
In that group, treatment lowered systolic blood pressure by 5.2 mmHg relative to the comparator and was associated with an 11% lower incidence of major cardiovascular events, including stroke, heart attack, ischemic heart disease, and heart failure leading to hospitalization or death. Among participants taking less than 80% of their medication, the blood-pressure difference was only 3.0 mmHg, and no statistically significant reduction in major events was detected.
Adherence also deteriorated despite the structured setting of clinical trials: 88% met the higher-adherence threshold in the first year, falling to 79% by year five. With roughly half of hypertension patients estimated not to take prescriptions as directed, the researchers argue that adherence should be assessed routinely and discussed without judgment. Simpler schedules, combination pills, and longer-acting medicines may help patients maintain treatment and reduce the impact of occasional missed doses.
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