BP drugs: patients missing out on heart benefits

Clinical takeaway: Routinely assess adherence in patients with hypertension, as the cardiovascular benefits of antihypertensive therapy may be substantially diminished in those who frequently miss doses.

Roughly half of patients prescribed blood pressure-lowering medications do not take them as directed. While poor adherence has long been linked to worse outcomes, most supporting evidence has come from observational studies, leaving uncertainty about how much nonadherence directly erodes the benefits of treatment.

In an analysis presented at ESC Congress 2026, researchers pooled individual patient data from nine randomized trials involving 91,339 participants who received either antihypertensive therapy or placebo/less-intensive treatment. Patients were categorized as having high adherence if they took at least 80% of prescribed medication and low adherence if they took less.

Adherence declined steadily over time, even within the closely monitored setting of clinical trials. The proportion of patients meeting the high-adherence threshold fell from 88% during the first year to 79% by year 5.

The difference translated into meaningful clinical outcomes. Among patients with high adherence, antihypertensive treatment lowered systolic blood pressure by 5.2 mmHg versus comparator therapy and reduced the risk of major cardiovascular events, including stroke, myocardial infarction, ischemic heart disease, and heart failure hospitalization or death, by 11%. In contrast, patients with low adherence achieved only a 3.0-mmHg reduction in systolic blood pressure and appeared to derive no significant cardiovascular benefit.

Investigators said the findings support making adherence assessment a routine component of hypertension care and highlighted strategies such as simplified regimens, single-pill combinations, and longer-acting agents to help patients stay on therapy. As a conference presentation, the results should be considered preliminary until published in a peer-reviewed journal.

“Our results reinforce the saying that ‘drugs don’t work in patients who don’t take them,’” presenter Qianqian Yang of the University of Oxford said. “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.”

Source: Yang Q, et al. (2026 Aug 27) Presented at ESC Congress 2026. Patients are missing out on the cardiovascular benefits of blood pressure-lowering medicines