In this issue of the Archives (p 1707), Alderman and Ochs document major deficiencies found in the long-term management of hypertensive patients treated in the outpatient department of a large teaching hospital. In reviewing the records of the clinic, they found that half of the hypertensive patients were unavailable for follow-up within six months of the initial visit. Of those who remained, less than 25% achieved a reduction of blood pressure to below 160/95 mm Hg. Furthermore, publication of controlled clinical trials demonstrating conclusively the effectiveness of drug treatment in hypertension failed to have any impact on the already unsatisfactory management of the clinic patients.
Finnerty et al1 attempted to uncover the reasons for the large number of dropouts from their teaching clinic. Their method was to question the patients who had dropped out. The patients complained that they were treated like second-class citizens. They said they waited three