Noncompliance is a major problem in antihypertensive treatment. Up to 50% of patients are noncompliant after 1 year and 85% after 5 years. Current approaches for predicting compliance are based on patient demographics, medication characteristics and clinical factors, health beliefs and the quality of patient-provider communication. All of these factors together predict compliance only less than half the time, indicating that over half of the patients in disease management programmes may not buy-in to their treatment.A new approach views compliance as behaviour change that takes place over time. Patients move through 5 stages in their ‘readiness to comply’. Our study of over 700 patients with hypertension using brief self-report measures to assess their ‘readiness to comply’ found a highly significant relationship between ‘readiness to comply’ and reported compliance. Clinicians can increase patient buy-in and long term compliance by assessing their patients ‘stage-of-change’ using validated measures and then matching their interventions to each patient's ‘readiness to comply’.