CLINICS 2010;65(9):857-863 calls’’showed significant reductions in blood pressure from the randomization visit to the final visit, as a high percentage of patients with good blood pressure control (BP ,140/90 mmHg) in the total group (74%), regardless of an increase in body weight throughout the study. In our study, the high percentage patients with controlled blood pressure at the end of treatment can be explained by the simple drug regimen, the simple drug acquisition provided by the physician at no cost at the end of each visit, a fixed team of physicians and nurses throughout the study period and the easy access to team members in cases of unexpected occurrences by means of unscheduled visits. We observed that in the next-to-last study visit, the ‘‘uncomplicated’’, ‘‘current’’, ‘‘traditional’’, ‘‘phone calls’’ and ‘‘no phone calls’’ groups had more patients with controlled blood pressure when compared to the last visit. It is possible that during the last visit the patients were worried about continuing the treatment and receiving the medications. Therefore, guidance provided to patients by means of active telephone calls, brochures and group workshops with healthcare professionals is an efficient strategy for reducing treatment discontinuation, the most severe type of non- compliance with treatment. Perspectives In an attempt to reduce non-adherence to antihyperten- sive treatment determinants in a developing country, we demonstrated that better blood pressure control was obtained through doctor’s visits every two months with the same physician preceded by nursing staff visits with patients receiving all medication necessary for their treat- ment; this benefit was independent of comorbidities and the type of treatment used. Guidance provided to the patients through active telephone calls, brochures, group workshops with healthcare professionals and donation of all the required medications significantly reduced the treatment discontinuation rates. Sources of Funding This study received support from ‘‘Biosintetica Assis- tance’’ and Biosinte´tica Laboratory, which donated all of the required medication. REFERENCES 1. Rosamond W, Flegal K, Furie K, Go A, Greenlund K, Haase N, et al. For the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics 2008 update: a report from the American Heart Statitistics Committee and Stroke Subcommittee. Circulation. 2008;117:e25-e146, doi: 10.1161/ CIRCULATIONAHA.107.187998. 2. Ong KL, Cheung BMY, Man YB, Lau CP, Lam KSL. Prevalence, awareness, treatment and control of hypertension among United States adults 1999–2004. Hypertension. 2007;49:69-75, doi: 10.1161/01.HYP. 0000252676.46043.18. 3. V Brazilian Guidelines in Arterial Hypertension. Arq Bras Cardiol. 2007;89:e24-79. 4. Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence (Cochrane Review). In:The Cochrane Library, Issue3, 2008. Compliance with antihypertensive treatment Ortega KC et al. 5. Gusma˜o JL de, Mion D Jr, Pierin AMG. Health-related quality of life and blood pressure control in hypertensive patients with and without complica- tions. Clinics, 2009;64:619-28, doi: 10.1590/S1807-59322009000700003. 6. Ma´rquez CE, Vegazo GO, Claros NM, Gil GV, de la Figuera von Wichmann M, et al. Efficacy of telephone and mail intervention in patient compliance with antihypertensive drugs in hypertension. ETECUM-HTA study. Blood Press. 2005;14:151-8, doi: 10.1080/ 08037050510008977. 7. Bosworth HB, Olsen MK, Neary A, Orr M, Grubber J, Syetkey L, et al. Take Control of Your Blood pressure (TCYB) study: a multifatorial tailored behavioral and educational intervention for achieving blood pressure control. Patient Education and Counseling. 2008;70:338-47, doi: 10.1016/j.pec.2007.11.014. 8. Rudd P, Miller NH, Kaufman J, Kraemer HC, Bandura A, Geenwald G, et al. Nurse management for hypertension. Am J Hypertens. 2004;17: 921-7. 9. Wu JYF, Leung WYS, Chang S, Lee B, Zee B, Tong PCY, et al. Effectiveness of telephone counselling by a pharmacist in reducing mortality in patients receiving polypharmacy: randomised controlled trial. BMJ. 2006;333:522-7, doi: 10.1136/bmj.38905.447118.2F. 10. Ho PM, Spertus JA, Masoudi FA, Reid KJ, Peterson ED, Magid DJ, et al. Impact of medication therapy discontinuation on mortality after myocardial infarction. Arch Intern Med. 2006;166:1842-7, doi: 10.1001/ archinte.166.17.1842. 11. Ho PM, Rumsfeld JS, Masoudi FA, McClure DL, Plomondon ME, Steiner JF, et al. Effect of medication nonadherence on hospitalization and mortality among patients with Diabetes Mellitus. Arch Inter Med. 2006;166:1836-41, doi: 10.1001/archinte.166.17.1836. 12. Weir MR. The rationale for combination versus single-entity therapy in hypertension. Am J Hypertens. 1998;11:163S-169S. 13. Ruzicka M, Leenen FH. Monotherapy versus combination therapy as first line treatment of uncomplicated arterial hypertension. Drugs. 2001;61:943-54, doi: 10.2165/00003495-200161070-00004. 14. Ekbom T, Linjer E, Hedner T, Lanke J, de Faire U, Wester P-O, et al. Cardiovascular events in elderly patients with isolated systolic hypertension. A subgroup analysis of treatment strategies in STOP-Hypertension-2. Blood Press. 2004;13:137-41, doi: 10.1080/ 08037050410014944. 15. Poulter NR, Wedel H, Dahlo¨ f B, Sever PS, Beevers DG, Caulfield M, et al. Role of blood pressure and other variables in the differential cardiovas- cular event rates noted in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA). Lancet. 2005;366:907-13, doi: 10.1016/S0140-6736(05)67186-3. 16. Dahlo¨ f B, Devereux RB, Kjeldsen SE, Julius S, Beevers G, de Faire U, et al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet. 2002;359:995–1003, doi: 10.1016/S0140-6736(02) 08089-3. 17. Mano GM, Souza VF, Pierin AM, Lima JC, Ignez EC, Ortega KC, et al. Assessment of the DIXTAL DX-2710 automated oscillometric device for blood pressure measurement with the validation protocols of the British Hypertension Society (BHS) and the Association for the Advancement of Medical Instrumentation (AAMI). Arq Bras Cardiol. 2002;79:601-5, doi: 10.1590/S0066-782X2002001500006. 18. O’Brien E, Petrie J, Littler WA, de Swiet M, Padfield PL, Altman D, et al. Short report. An outline of the British Hypertension Society Protocol for the evaluation of blood pressure measuring devices. J Hypertens 1993;11:677-9, doi: 10.1097/00004872-199306000-00013. 19. Association for the Advancement of Medical Instrumentation. American national standart. Eletronic or automated sphygmomanometers, ANSI/ AAMI SP 10-1992. Arlington, VA:AAMI 40,1993. 20. Osterberg L, Blaschke T. Drug therapy: adherence to medication. NEJM. 2005;353:487-97, doi: 10.1056/NEJMra050100. 21. Horwitz RI, Horwitz SM. Adherence to treatment and health outcomes. Arch Intern Med. 1993;153:1863-8, doi: 10.1001/archinte.153.16.1863. 22. Macharia WM, Leon G, Rowe BH, Stephenson BJ, Haynes RB. An overview of interventions to improve compliance with appointment keeping for medical services. JAMA. 1992;267:1813-7, doi: 10.1001/jama. 267.13.1813. 23. Friedman RH. Automated telephone conversations to assess health behavior and deliver behavioral interventions. J Med Syst. 1998;22:95- 102, doi: 10.1023/A:1022695119046. 24. Monane M, Bohn RL, Gurwitz JH, Glynn RJ, Levin R and Avorn J. The effects of initial drug choice and comorbidity on antihypertensive therapy compliance: results from a population-based study in the elderly. Am J Hypertens. 1997;10:697-704. 863