Role of paraprofessionals in improving compliance with antihypertensive treatment

Community blood pressure (BP) surveys in the past indicated that less than 25% of the total hypertensive population was under good BP control. Over the past decade there has been a systematic attempt to involve paraprofessionals in community based hypertension control programmes. Highly successful model programmes have used either a health-care team or a physician with a specially trained nurse approach, with good BP control being achieved by the active involvement of paraprofessionals in the treatment process. Patients in these special programmes are more likely to be on antihypertensive medication, are more compliant with prescribed therapy and are less likely to drop out of care. On the other hand, the utilization of paraprofessionals to monitor the antihypertensive care of patients with uncontrolled hypertension at regular intervals does not significantly improve BP control, nor does it substantially alter medication compliance or lower the treatment drop out rate. Hypertension control programmes targeted at special groups, such as working men and women and designed to link identified individuals with uncontrolled hypertension to a source of medical care, are associated with a significant improvement in BP control, indicating the potential usefulness of such screening programmes.