Improving compliance in an inner-city hypertensive patient population.

Because hypertension is a "silent" disease process, compliance with therapy is always a problem. In the inner city, where socioeconomic factors such as poverty, illiteracy, and substance abuse raise additional barriers to effective health care, poor compliance with antihypertensive regimens can reach epidemic proportions--as it did in our clinic in the early 1970s. After identifying the major causes of poor compliance in our patients, we instituted measures that led directly to greatly improved compliance and control, among them the expansion of clinic hours, the expediting of laboratory services, and the training of nurse-therapists to assume many of the responsibilities of running the clinic.

Centrally acting alpha-2 agonists, peripherally acting adrenergic-blocking drugs, and direct vasodilators in the treatment of mild and moderate essential hypertension.

The experience with three groups of antihypertensive agents in a large hypertension clinic serving a black patient population is reported. A retrospective review of clinic records was undertaken to determine the efficacy and adverse effects of the centrally acting adrenergic agonists methyldopa and clonidine, the alpha-1 antagonist prazosin, and the direct vasodilator hydralazine in patients with mild and moderate hypertension. Treatment with methyldopa, clonidine, or prazosin, usually in combination with a diuretic produced a 30 to 38 mmHg decrease in systolic blood pressure, and a 24 to 28 mmHg reduction in diastolic blood pressure.