ABSTRACT
Whether and how people take their medication, and whether they continue follow-up, depends on their own system of beliefs about health and disease in general, and about high blood pressure in particular, with whatever modifications professionals can teach. In the USA at least, it seems that compliance and drop-out are worst in the patients at highest risk; they are worse in blacks than in whites, and worse in men than in women. The condition for maximal compliance is therefore an open mind; all patients who really need antihypertensive treatment should be offered it, with an initial presumption of innocence. To maximize compliance and minimize drop-out, most of the work involved in follow-up must be essentially educational: professionals educating patients through data about their bodies, patients educating professionals through data about their lives. An agreed informal contract is particularly important for the minority of patients who reject treatment, either from the start, or by systematic non-compliance.
