Screening programmes in shopping centres or housing blocks do not reach the disadvantaged groups often intended. Case finding appears to be particularly effective when linked with professional training, protocols and reminders to record blood pressure given to both patients and doctors. Ambulatory monitoring does not have any role in the detection of hypertension in the population. No single approach to improving adherence can be recommended based on the evidence reviewed. Complex interventions involving education, easier access to care, and use of protocols may improve adherence and control in some patients.
Educational interventions are unlikely to be effective on their own.
While simpler drug regimens are likely to improve adherence, simple reminder packaging does not improve adherence or control. Patient education alone is unlikely to improve blood pressure control. Professional education may make a small contribution to blood pressure control, but is probably due to increased use of drug therapy. The issuing and use of guidelines does not result in improvements in care. Locally, rather than expert, produced guidelines that are integrated into clinical practice improve both practice and clinical outcomes.