THE DISAPPEARING HYPERTENSIVES

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Abstract
Previous studies on the effect of educating the hypertensive patient yielded conflicting results in terms of improving compliance. The marked effect that patient counseling together with compliance checks can have in improving blood pressure control was demonstrated in a difficult group. Patients were selected for study because they appeared to be resistant to complicated antihypertensive therapy and were therefore likely to be changed to more toxic drugs. The severity of their hypertension was such that failure to control their blood pressure could have led to serious morbidity or even premature death, both of which may be prevented by satisfactory blood pressure control. Two factors contributed to the success of this particular trial. The patients who were considered refractory hypertensives were given more attention than is normally the case in a busy routine clinic. Questioning and counselling were performed in 20-25 min at the initial visit and follow-up interviews were not unduly prolonged. Non-compliance was detected objectively using rapid spot checks on the urine. Normally the physician can only suspect that his instructions are not being followed. The counseling and the urine checks are relatively simple and could be incorporated into almost any hypertension clinic when the need arises.