The changing face of hypertension and antihypertensive agents.

In summary, much is needed to be done to foster thinking, both by patients and healthcare providers, in terms of disease risks and benefits of medical care, including those of pharmaceutical options. Healthcare professionals have been relatively ineffective patient educators, perhaps because there is still the old paternalism of 'doctor knows best'. Also, insufficient attention has been given to enhance the communication skills of healthcare professionals. Very likely, one of the reasons is the pressure to control costs which limits the time that healthcare professionals spend consulting with patients. Less than ideal compliance has even been reported in large-scale trials. For example, in the SHEP trial, a 90% compliance was reported (perhaps because of patient selection) but in the Studies of Left Ventricular Dysfunction (SOLVD), only 80% compliance was achieved. Poor adherence to long term treatment, both lifestyle modifications and pharmacological therapy, has been identified as the major reason for inadequate control of elevated BP; some sources claim that only 25% of all hypertensive patients have controlled BP. Thus planned patient education efforts should be undertaken as these can significantly improve BP control and decrease hypertension-related morbidity and mortality. To achieve this, the patient must become an active participant in the planned regimen, and not remain a passive recipient (table III).