The essence of effective treatment and compliance is simplicity

In recent years, several international bodies of experts have established e xtensive guidelines for the prevention and treatment of coronary heart dise ase (CHD) that clearly define the importance of altering patients' lifestyl es and administering therapeutic agents that positively affect disease prog ression. However, surveys of actual clinical practice have revealed that ma ny of the key recommendations within these guidelines are not being impleme nted. The causes of this current undertreatment of CHD, although complex an d varied, can be tackled in two main ways: by increasing physician adherenc e to guideline recommendations and by increasing patient compliance to medi cation. Experience shows that the existence of guidelines is not enough to ensure t hat physicians consistently apply the messages they contain. Difficulties i n extrapolating clinical trial data to their patients, insufficient knowled ge of the disease area, time constraints, and economic issues are a few exa mples of the barriers that may prevent physicians from achieving best pract ice. One way of addressing at least some of these problems may be to make g reater use of nurses and other healthcare professionals, both in hospitals and in the primary care setting. Physicians must also be persuaded to emplo y longterm management and prevention strategies, as opposed to focusing on the short-term perspective. In doing so, the use of highly efficacious agen ts with a low incidence of associated adverse events will be the most succe ssful in terms of maintaining patient compliance. Am J Hypertens 1999; 12:1 05S-110S (C) 1999 American Journal of Hypertension, Ltd.