Patients are missing out on the cardiovascular benefits of blood pressure-lowering medicines, say researchers

Researchers warn that patients are missing out on the cardiovascular benefits of blood pressure-lowering medicines due to poor adherence to prescribed medication. Approximately 1.4 billion adults worldwide aged 30-79 have high blood pressure, a significant risk factor for disease burden. Despite the proven benefits of antihypertensive medication, around half of patients do not take medication as prescribed.

The study, presented at ESC Congress 2026, analyzed patient-level data from nine randomized trials involving 91,339 participants. Researchers classified patients as having higher or lower adherence based on whether they took at least 80% or less than 80% of their assigned treatment, respectively. Even in a structured trial setting, a decline in adherence was observed, with the proportion of patients classified as having higher adherence falling from 88% in the first year to 79% by year five.

Patients with higher adherence experienced a greater reduction in systolic blood pressure (5.2 mmHg) compared to those with lower adherence (3.0 mmHg). Furthermore, the incidence of major cardiovascular disease, including stroke, myocardial infarction, ischemic heart disease, and heart failure, was significantly reduced by 11% in patients with higher adherence compared to the comparator group. However, there appeared to be no significant reductions in patients with lower adherence.

The researchers emphasize that adherence assessment and education should be more prominent in hypertension management. Strategies to improve adherence include simplifying medication regimens, using single-pill combinations, and employing longer-acting agents to minimize the impact of occasional missed doses. Professor Felix Mahfoud, chair of the ESC Communication Committee, stresses that nonadherence to medication should be recognized as a cause of uncontrolled hypertension and become a routine part of hypertension care.