CLINICS 2010;65(9):857-863 CLINICAL SCIENCE DOI:10.1590/S1807-59322010000900008 How to avoid discontinuation of antihypertensive treatment. The experience in Sa˜ o Paulo, Brazil Katia Coelho Ortega,I Josiane Lima de Gusma˜ o,I,III Angela Maria Geraldo Pierin,II Jose´ Luiz Nishiura,I Edna Caetano Ignez,I Carlos Alexandre Segre,I Carlucci Gualberto Ventura,I Gisele Peixoto Mano,II Viviane Fontes,II Francisco Mogadouro da Cunha,I De´ cio Mion, Jr.I I Hypertension Unit, Hospital das Clı´nicas, Faculdade de Medicina, Universidade de S a˜o Paulo, S a˜o Paulo, SP, Brazil. II Escola de Enfermagem, Universidade de S a˜o Paulo, S a˜o Paulo, SP, Brazil. III Guarulhos University, Guarulhos, SP, Brazil. OBJECTIVES: To evaluate the importance of providing guidelines to patients via active telephone calls for blood pressure control and for preventing the discontinuation of treatment among hypertensive patients. INTRODUCTION: Many reasons exist for non-adherence to medical regimens, and one of the strategies employed to improve treatment compliance is the use of active telephone calls. METHODS: Hypertensive patients (n = 354) who could receive telephone calls to remind them of their medical appointments and receive instruction about hypertension were distributed into two groups: a) ‘‘uncomplicated’’ – hypertensive patients with no other concurrent diseases and b) ‘‘complicated’’ - severe hypertensive patients (mean diastolic $110 mmHg with or without medication) or patients with comorbidities. All patients, except those excluded (n = 44), were open-block randomized to follow two treatment regimens (‘‘traditional’’ or ‘‘current’’) and to receive or not receive telephone calls (‘‘phone calls’’ and ‘‘no phone calls’’ groups, respectively). RESULTS: Significantly fewer patients in the ‘‘phone calls’’ group discontinued treatment compared to those in the ‘‘no phone calls’’ group (4 vs. 30; p,0.0094). There was no difference in the percentage of patients with controlled blood pressure in the ‘‘phone calls’’ group and ‘‘no phone calls’’ group or in the ‘‘traditional’’ and ‘‘current’’ groups. The percentage of patients with controlled blood pressure (,140/90 mmHg) was increased at the end of the treatment (74%), reaching 80% in the ‘‘uncomplicated’’ group and 67% in the ‘‘complicated’’ group (p,0.000001). CONCLUSION: Guidance to patients via active telephone calls is an efficient strategy for preventing the discontinuation of antihypertensive treatment. KEYWORDS: Hypertension; Medication Compliance; Patient Adherence; Therapeutics; Antihypertensive Drugs. Ortega KC, Gusma˜ o JL, Pierin AMG, Nishiura JL, Ignez EC, Segre CA, et al. How to avoid discontinuation of antihypertensive treatment. The experience in S a˜o Paulo, Brazil. Clinics. 2010;65(9):857-863. Received for publication on April 12, 2010; First review completed on May 12, 2010; Accepted for publication on June 18, 2010 E-mail: katiaortega29@gmail.com Tel.: 55 11 3069-7686 INTRODUCTION Most patients with hypertension do not benefit from treatment.1 Data from NHANES/NCHS 1999–2004 showed that 71.8% of individuals were aware of their condition, 61.4% were under current treatment and 35.1% had it under control.2 Although the percentage of individuals with controlled blood pressure in Brazil is unknown, we estimate it to be low because the percentage of patients with their high blood pressure under control is around 30-35% at outpatient clinics that specialize in hypertension, and these clinics do not represent the national reality.3 Copyright 2010 CLINICS – This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non- commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Many reasons exist for non-adherence to medical regi- mens, including adverse drug effects, poor instructions, poor provider-patient relationship, poor memory, a patient’s disagreement with the need for treatment or inability to afford medication.4,5 One of the strategies employed to improve treatment compliance is the use of active telephone calls6 to patients through which they are given guidance and treatment questions are answered. Using this strategy, several studies have shown an increase in treatment compliance, a higher percentage of blood pressure control6-8 and a decrease in mortality.9-11 Another strategy that aims at improving treatment compliance is the employment of two low-dose medica- tions. Evidence suggests that the combination of two antihypertensive agents provides a higher percentage of blood pressure control due to complementary mechanisms of action. In addition, this results in better tolerability and consequently, better treatment compliance.12-14 857