[Predictive value of patient psychological profile and type of physician-patient relationship in compliance of antihypertensive treatment].

The files of 4614 hypertensive patients monitored by general practitioners (GP) were methodically analyzed. 49 p. 100 of these subjects had received no previous treatment. The protocol consisted of obligatory consultations 2, 6 and 12 months after inclusion, and questionnaires requiring specific answers, designed to describe the patient-practitioner relationship. The GP provided a psychological evaluation upon inclusion. Four main compliance classes were defined according to the data collected over 12 months: patients present at all times of the study and scrupulously respecting the medical prescription (class A: 36 p. 100 of the studied population) or neglecting the prescription (B: 33 p. 100), patients omitting one or several appointments but reestablishing contact (C: 2 p. 100) and patients lost to follow-up (D: 18 p. 100). Blood pressure parameters were better in class A as of the consultation at 2 months (ANOVA). Paradoxically, a self-assured, outgoing, serene character is a prediction factor for less satisfactory compliance than a passive, hesitant, reserved, worried character. GP behaviors were classified into homogeneous groups by principal component factorial analysis: positive prognosis factors as regards compliance are an attitude of "building up confidence" (reassuring the patient, announcing that treatment will allow him to relax, evoking possible side-effects in advance) or "medicalization of hypertension" (presented as a pathology rather than merely as a risk factor, with life-long treatment as a corollary). On the other hand, a poor prognosis factor is an attitude of "dramatization" (frightening the patient). "Building up confidence" is linked to better compliance, whatever the associated risk factors. This study statistically confirms the role of the patient-practitioner relationship in compliance.