Practical aspects of dietary management of hypertension: compliance

Abstract

This paper addresses compliance issues that arise in the implementation of weight loss and other therapeutic diets prescribed for the individual with hypertension. Dietary compliance poses a significant problem. Studies suggest that dropout rates in both self-help and other weight loss programs range from 50 to 70% within 1–2 years. Further, just 50% of persons can be expected to comply with diets for cardiovascular disease. Assessment of adherence is confounded by the lack of precise measures that reflect adherence over time. Measures in general use include daily diaries, urinary chloride dip sticks, multiple 24-h or overnight urinary sodium, analysis of food samples, as well as 24-h recall and food histories. When poor compliance has been identified, it has been associated with a variety of factors. These include multicomponent regimens, conflicting lifestyle habits, skill in identifying and (or) preparing appropriate foods, the cost: benefit ratio of compliance, and social support. Limited investigation has been undertaken to directly improve compliance to diet. However, such strategies as tailoring, goal setting, self-monitoring, stimulus control, social support, cognitive restructuring, and a consistent approach between the care providers show promise.