This double-blind, double-dummy, randomized clinical trial, conducted in elderly patients with mild hypertension, compared adherence to treatment, efficacy, side effects, and quality of life during treatment with transdermal clonidine versus oral sustained-release verapamil (verapamil-SR). Blood pressure declined significantly-from 148/95 mm Hg at baseline to 139/84 after titration and 135/86 after maintenance-with transdermal clonidine (n = 29), and from 156/96 to 144/85 and 148/88, respectively, with verapamil-SR (n = 29). Adverse event rates and quality-of-life questionnaire responses were similar in the two treatment groups. Transdermal clonidine was worn as directed during more than 96% of patient weeks of treatment. Compliance with the oral verapamil regimen was less consistent: Verapamil-SR was taken as directed during approximately 50% of patient-weeks of therapy, and individual compliance, assessed by tablet counts, varied from 50-120%. In all, 86% of subjects were satisfied or highly satisfied with the convenience of transdermal therapy; 87% reported that side effects were slightly or not bothersome; 65% indicated that transdermal patches were more convenient than oral therapy; and almost 60% preferred transdermal to oral therapy. In this study transdermal clonidine and oral verapamil were equally safe and effective. A substantial majority of patients preferred transdermal to oral therapy, and adherence to treatment was greater with transdermal therapy., Patient compliance is always a problem that must be considered in the practice of medicine. Unfortunately, the problem is especially serious in treating high blood pressure (hypertension), since patients with hypertension often feel fine and have little immediate motivation to take pills. Some medications can be administered by transdermal patch, which may be a good method for improving patient compliance. The transdermal patch is stuck onto the skin; this bandage-like device leaks drug into the skin at a very slow rate and the drug can then be carried away by the blood. The antihypertensive drug clonidine is available in a transdermal patch that can be effective for a week. A study was conducted to compare the compliance of patients using the transdermal patch with that of patients taking oral doses of verapamil, another antihypertensive drug. All 58 patients participating in the study were 60 or over and had mild hypertension. The patients were randomly assigned to receive either oral verapamil or the clonidine patch; the clonidine group also received placebo pills and the verapamil group also received dummy patches. Blood pressure declined significantly for both groups. The systolic blood pressure (pressure at the highest point of the pulse) declined from an average of 148 to 135 for the clonidine group and from 156 to 148 for the verapamil group. Patient compliance was virtually complete for the patches. However, neither the clonidine group nor the verapamil group took their pills regularly, which was determined by pill-counting. Fewer than 27 percent of the patients taking verapamil and fewer than 88 percent of the patients taking clonidine had the right number of pills. A significant fraction of the patients had too few pills. The side effects of the two different treatment methods in the present study were comparable, but the patients expressed greater satisfaction with the transdermal patch than with the pills. (Consumer Summary produced by Reliance Medical Information, Inc.)