Long-term therapy of hypertension.

Abstract

Hypertension is a major chronic disorder which calls for a long-term treatment. The success or failure of the treatment of chronic diseases depends largely on the compliance of patients. So, the success of the treatment of hypertension will be influenced by good compliance, ideal antihypertensive agents and the improvement of the system which can lower medical expenses. The long-term use of antihypertensive agents causes adverse effects and tolerances. Some kind of antihypertensive agents have an effect on the metabolic aspects, particularly like the worsening of the serum lipids and lowering of the glucose tolerance. Recently, the availability of the ambulatory blood pressure monitoring is being emphasized in the diagnosis of hypertension, the timing of initiation or withdrawal of antihypertensive agents and evaluation of the efficacy of the drugs. On the other hand, the frequency and the predicting parameters of the complication, which occurs during the treatment, should be considered in relation with other risk factors and special consideration is needed for the selection of the antihypertensive agent when the concurrent disorder is present. We1,2) have urged the interest of physicians on the several problems as above which were accompanied by the long-term therapy with antihypertensive agents, and would like to report the result of analysis of the data, which has been gathered in the hypertension clinic of Seoul Paik Hospital, Inje University for 15 years, in order to recollect these problems and draw out the resolutions. Long-Term Therapy and Compliance The core of the effective long-term therapy with antihypertensive agents is to improve the compliance of patients. The high compliance results from the interaction among patients, doctors and social conditions. Nessman et al. recommended the following as methods which could improve compliance. The first one was utilization of the educational materials. The second, education of health care officials. The third, home visiting. The fourth, home care. The fifth, measurement of blood pressure at home. The measurement of compliance can be done by several methods. In our clinic, it has mainly been measured in terms of the scores of visiting the clinic. In other clinics, it has been measured in terms of the scores of taking medicine3). But the modification of the life style should be considered in measuring compliance. (Table 1) Table 1. Measurement of Compliance