Risk factor modification in hypertension--success and failure.

A group of 175 patients have attended for four years a microcomputer based, nurse practitioner managed clinic for the long term care of hypertension. Improvement in blood pressure (BP) control was seen initially and has been maintained. Drug treatment has been with a beta blocker followed if necessary by a diuretic and/or a vasodilator. Despite individual dietary and 'stop smoking' advice, there was no marked change in body weight while only males reduced smoking. A significant increase in non fasting serum cholesterol (6.4 +/- 1.3 to 6.6 +/- 1.3 mmol/l) and glucose (5.5 +/- to 6.1 +/- 2.5 mmol/l) was seen overall, but was restricted to those patients taking a thiazide diuretic (with or without other drugs). These findings indicate the need for a more systematic collection of information on effects of long term treatment and for the development of better strategies for improving lifestyle.