The problem of non-compliance in long-term antihypertensive therapy

Of 1,593 subjects admitted to the Australian National Blood Pressure Study 1 to 2 years ago, a substantial number (391 or 24.5%) ceased attending, in 85% of cases voluntarily. Withdrawal rates were very high in the first 4 months, settling to 5% per annum by the second year. Extrapolation to clinical practice is hazardous but contibutory factors elicited by questionnaire suggest certain management strategies: maximisation of efforts to enlist subject co-operation at the onset of treatment; management of treatment by family doctor or health centre with appointments flexible in time and infrequent in number; minimisation of doctors' ambivalence about treatment effectiveness and the withholding of information from the subject. It is inevitable that a proportion of subjects will reject long-term drug treatment. This adds further weight to the need for research on alternatives such as low salt diets.