Compliance with antihypertensive treatment Ortega KC et al. pathy (1), diabetic decompensation (1), syncope (1), nephrectomy (2), trauma (2), peritoneal bypass (1), diarrhea (1) and gastrectomy (1). The results of the laboratory tests performed in the beginning and end of the study are shown in Table 6. There was an increase in the 24-hour urinary sodium excretion from the beginning to the end of the study (120¡46 vs. 129¡45 mEq/L, respectively; p = 0.000036) DISCUSSION Adherence to a medication regimen is generally defined as the extent to which patients take medications as prescribed by their health care providers.20 This can be classified into three aspects of the individual’s behavior regarding his/her health: 1) take the medication correctly, 2) follow the professionals’ instructions related to diets and lifestyle changes and 3) attend medical visits.21 The discontinuation of medication is considered the most serious type of noncompliance with treatment. In our study, the ‘‘phone calls’’ group showed a significantly lower percentage of patients who discontinued treatment com- pared with the ‘‘no phone calls’’ group. A meta-analysis of randomized studies22 suggested that treatment disconti- nuation is effectively avoided by contacting the patient using letters, telephone calls or e-mails. Ma´rques Contreras et al.6 evaluated the efficacy of telephone and e-mail intervention for therapeutic compliance among 538 patients with mild to moderate hypertension and verified that the group that received phone calls showed higher compliance rates (96.2%) than the group that was only contacted by e-mail (91.3%) or the group that did not receive any intervention (69.2%). Similar data were found in a controlled study recently conducted by Bosworth et al.7 in which the self- reported medication adherence was shown to increase by 9% in the group that had received behavioral and educational intervention (319 hypertensive subjects) through telephone calls versus 1% in the group that had not received interven- tion (n = 317). Friedman et al.23, through telephone calls associated with usual medical care for six months, compared hypertensive patients who received their usual medical treatment with those who used a monitoring and counseling system. Participants with compliance below 80% of the prescribed medication prior to enrollment in the study showed better CLINICS 2010;65(9):857-863 compliance with the treatment when the telephone mon- itoring system was used than did patients who did not use the system (36% vs. 26%, respectively). On the other hand, participants with a compliance level above 80% prior to enrollment in the study did not show any change in compliance, and compliance was comparable in users and non-users of the telephone monitoring system. In our study, regardless of the group to which they were randomized, patients showed compliance rates above 85% at all visits. However, we do not have data regarding medication compliance before enrollment in the study. It is important to point out that treatment compliance is directly related to mortality. A study conducted by Wu et al.9 randomized 442 non-compliant patients who took five or more medications for chronic illnesses to either receive or not receive telephone counseling. The objective was to investigate the influence of this advice for treatment compliance and patient mortality. The study verified that telephone counseling was associated with a 41% reduction of death risk after two years. These authors used scores to classify the levels of compliance of 1011 patients, and they showed that the lower the level of compliance, the higher the risk of mortality in the long term. The influence of the initial selection of antihypertensive medication in regards to compliance with treatment was evaluated by Monane et al.24 The authors verified that the use of newer antihypertensive agents, such as angiotensin converting enzyme inhibitors and calcium channel antago- nists, was associated with a compliance $80% when compared with thiazide diuretics in patients with cardiac morbidities and multiple visits to physicians. This may have been the result of better tolerability to newer classes of antihypertensive agents. However, in our study, there was no difference in tolerability between the ‘‘traditional’’ and ‘‘current’’ groups, which could explain the similar compli- ance rates in both groups. On the other hand, just like in Monane et al.24 we found that fewer patients in the ‘‘complicated’’ group had their blood pressure under control in the final visit (67%), whereas in the next to last study visit, 90% of patients in the ‘‘uncomplicated’’ group and only 66% in the ‘‘complicated’’ group had blood pressure levels below 140/90 mmHg. This may be due to comorbidities and the use of other concurrent treatments. The groups: ‘‘complicated’’ and ‘‘uncomplicated’’; ‘‘tradi- tional’’ and ‘‘current’’; ‘‘phone calls’’ and ‘‘no phone Table 6 - Results of laboratory tests measured at the beginning and end of the study. Fasting Glucose (mg/dL) Urea (mg/dL) Creatinine (mg/dl) Total Cholesterol (mg/dL) HDL Cholesterol (mg/dL) Triglycerides (mg/dL) Uric Acid (mg/dL) Sodium (mEq/L) Potassium (mEq/L) Hemoglobin (g/dL) Alkaline Phosphatase (U/L) ALT (U/L) AST (U/L) Sodium Urinary Excretion in 24 h (mEq/L) Data are shown as mean¡s.d. Initial 108¡41 32¡10 0.9¡0.3 199¡44 49¡13 147¡123 5.1¡1.5 140¡3.2 4.2¡0.5 14.4¡1.4 79.7¡25.3 23.5¡10.6 24.4¡15.9 119.6¡45.6 862 Final 111¡41 34¡16 1.0¡0.4 190¡38 48¡14 152¡218 5.3¡1.8 139¡2.7 4.2¡0.4 14.2¡1.3 75.1¡22.7 26.6¡51.0 30.2¡92.5 128.8¡45.3 Test value 1.82 3.83 5.52 5.07 1.19 0.61 3.90 7.34 1.21 4.73 5.29 1.15 1.18 12.81 P value .0.05 = 0.00015 ,0.000001 = 0.000001 .0.05 .0.05 = 0.00011 ,0.000001 .0.05 = 0.000003 ,0.000001 .0.05 .0.05 = 0.000036