Duggan S, Eccles M P, Steen N, Jones S, Ford G A
Centre for Health Services Research, Department of Medicine (Geriatrics), University of Newcastle upon Tyne, UK.
Age Ageing. 2001 Jan;30(1):73-6. doi: 10.1093/ageing/30.1.73.
the benefits of treatment of hypertension in older people are well-established but implementation of this knowledge may be sub-optimal. We have determined recent primary care management of older people with hypertension.
we examined health records (n = 6986) of a 1 in 7 sample of patients aged 65-80 years from a random sample of practices (n = 51) in the former Northern Region of the UK, stratified by health authority, for the previous 6 years. We recorded documented risk factors, diagnosis of hypertension, three most recent blood pressure readings, current drug therapy and previous blood pressure lowering therapy, and presence of coexistent pathology.
blood pressure was defined as hypertensive (> or = 160/> or = 90 mmHg; one or both values above these limits), normotensive or undetermined using a validated algorithm. In 30% of patients, blood pressure status was undetermined. Thirty-five percent of subjects were found to be hypertensive. Of these, 70% were receiving antihypertensive treatment but only 30% of treated patients had controlled (< 150 and 90 mmHg) and 13% well controlled (< 140 and 85 mmHg) blood pressure. In all, 14% of older hypertensive patients were detected, treated and had their hypertension controlled. There were significant differences between practices in the proportion of hypertensive patients treated (P < 0.001) and in the proportion of hypertensive patients whose blood pressure was controlled (P < 0.01).
treatment of hypertension in older people in primary care has improved in terms of detection and treatment but in only one-third of patients is high blood pressure controlled. There remain important opportunities for prevention of stroke and myocardial infarction in this age group through achieving improved blood pressure control.
老年人高血压治疗的益处已得到充分证实，但这一知识的应用可能并不理想。我们已确定了近期老年人高血压的初级保健管理情况。
我们检查了英国前北部地区51家诊所随机抽取的七分之一样本中65 - 80岁患者的健康记录（n = 6986），按卫生当局进行分层，记录过去6年的情况。我们记录了已记录的风险因素、高血压诊断、最近三次血压读数、当前药物治疗和既往降压治疗情况，以及并存疾病的存在情况。
使用经过验证的算法将血压定义为高血压（≥160/≥90 mmHg；一个或两个值高于这些限值）、血压正常或未确定。30%的患者血压状态未确定。35%的受试者被发现患有高血压。其中，70%正在接受抗高血压治疗，但只有30%的治疗患者血压得到控制（<150和90 mmHg），13%控制良好（<140和85 mmHg）。总体而言，14%的老年高血压患者被检测出、接受治疗并使其高血压得到控制。各诊所之间在接受治疗的高血压患者比例（P < 0.001）和血压得到控制的高血压患者比例（P < 0.01）方面存在显著差异。
初级保健中老年人高血压的治疗在检测和治疗方面有所改善，但只有三分之一的患者高血压得到控制。通过改善血压控制，在这个年龄组预防中风和心肌梗死仍有重要机会。
