Improvement of hypertension care by a structured treatment and teaching programme

Despite the availability of multiple nonpharmacological and pharmacological antihypertensive regimens large scale control of BP on a population basis is still unsatisfactory. To achieve a better quality in hypertension care we have developed and evaluated a structured outpatient hypertension treatment and teaching programme. This programme aims at improving of patients' compliance to antihypertensive therapy and is based on four groups sessions mainly conducted by paramedical personnel. This programme was evaluated in three different settings: in patients with hypertension, diabetes mellitus and poor compliance to antihypertensive drug therapy; in blind patients with diabetic nephropathy and severe hypertension; and in patients with essential hypertension as treated by primary healthcare physicians in general practice. In all three studies a significant improvement in compliance to antihypertensive therapy and, hence, in BP control was demonstrated leading to preservation of renal function in diabetic nephropathy and fewer drug prescriptions in essential hypertension. In conclusion, studies evaluating the effect of large scale implementation of such structured treatment and teaching programmes on the quality of hypertension care in the community should be carried out.