Introduction

The potential benefit of vigorous medical treatment for hypertension often remains out of reach, in part because the patient does not comply with treatment. We believe that this non-compliance is a major barrier to the effective control of hypertension and that our understanding of this phenomenon is primitive. In phase I of a trial of strategies for improving compliance we found that neither the mastery of facts about hypertension nor receiving care and follow-up at work in “company time” led to any improvement. We describe here the second phase of this trial in which the application of more behaviourally oriented strategies did lead to improvements in both compliance and blood-pressure control.

Methods

These have been described in detail elsewhere. Briefly, the examination of 5400 men at Dominion Foundries and Steel Company (over 95% of a random two-thirds sample of male employees) yielded 245 who had high blood-pressures (when sitting quietly on three separate days, a standard series of fifth-phase diastolic blood-pressure were ≥95 mm Hg), were free of remediable forms of hypertension, were taking no daily medications (70 men were on treatment and were therefore excluded), and had not been treated for hypertension in the preceding six months.

In phase I of this trial, men were randomly allocated into a factorial design in order to test strategies affecting either the convenience of their follow-up care or their knowledge about hypertension and its treatment.