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A total of 123 patients with Primary hypercholesterolemia were randomized on a 2:1 ratio to receive either fluvastatin at 20 mg once daily at night (n = 82) or gemfibrozil at 600 mg twice daily (n = 41) in a double-blind, double-dummy comparison of the effects on plasma lipid parameters and tolerability over 8 weeks. All patients had either low-density lipoprotein cholesterol (LDL-C) concentrations [greater than or equal to] 160 mg/dL (4.1 mmol/L) in association with definite coronary artery disease (CAD) or [greater than or equal to] 2 risk factors, or LDL-C [greater than or equal to] 190 mg/dL (4.9 mmol/L) with no CAD and 20% in LDL-C levels. Normalization of LDL-C levels was achieved (according to European Atherosclerosis Society guidelines) by 13.4% of fluvastatin- and 14.6% of gemfibrozil-treated patients. Both drugs were well tolerated; adverse events occurred in 36.6% of fluvastatin recipients compared with 58.5% of patients taking gemfibrozil. No clinically notable elevations of aspartate or alanine aminotransferases, alkaline phosphatase, or creatine phosphokinase occurred. No patient developed new or worsening lens opacities associated with a reduction in optically corrected visual acuity. The most commonly reported adverse events were headache and gastrointestinal upset. There were no serious drug-related adverse events.

Overwhelming trial evidence indicates that the treatment of hypertension is beneficial, but in practice, less than 50% of treated hypertensive subjects have blood pressure well controlled. The success of treatment relies on acceptance by the patient. Treatment acceptance may be affected by the efficacy and tolerability of drug therapy, its effects on quality of life, and other important but less well-recognized influences such as the expectations and preconceived ideas of the physician and the patient. This report briefly reviews the factors affecting patient concordance with antihypertensive treatment and the role these factors play in the development of an integrated treatment plan. Nonconcordance with drug therapy is common: Only one third of patients always take treatment, one third take it sometimes, and one third never take their prescribed medication. With poor concordance, control of blood pressure and the consequent benefits are less likely to be realized. The factors that influence concordance are ill understood. Although drug side effects and convenience of dosing regimens are contributors, the attitudes of patients, physicians, and their interactions are likely to be of considerable importance. Concordance may be improved by involving the patient in the treatment plan, setting explicit targets, following a clear treatment plan, motivating the patient to comply with treatment, paying attention to the concerns and particular needs of the individual patient, and by ensuring frequent contacts between patients and health care professions. Successful integrated approaches to the management of hypertension must address all the factors that affect treatment acceptance. (Am Heart J 1999;138:S252-S255.)