McNeil B J, Adelstein S J
N Engl J Med. 1975 Jul 31;293(5):221-6. doi: 10.1056/NEJM197507312930503.
An attempt was made to discover the difference in outcomes between treating all patients with essential and renovascular hypertension by drug therapy independent and ignorant of etiologic classification and identifying the patients with renovascular disease and operating on them. Outcomes were categorized as well without complications of hypertension, alive but suffering from a related morbid illness such as coronary or cerebral arterial disease, and dead from the complications of diagnosis, surgery or high blood pressure. The identification and surgical treatment of hypertensive renovascular disease resulted in an incremental benefit in morbidity over blind antihypertensive medical therapy only when the compliance with medical treatment was about 50 per cent or less (the rate suggested for most patient populations). The study underscores the extent to which the quantitative efficacy of diagnositc and therapeutic procedures depends not only on the inherent risks and benefits but also on related social and medical factors.
一种是不考虑病因分类，独立且盲目地对所有原发性和肾血管性高血压患者进行药物治疗；另一种是识别出患有肾血管疾病的患者并对其进行手术治疗。结果也被分类为：无高血压并发症、存活但患有相关疾病（如冠状动脉或脑动脉疾病）、死于诊断、手术或高血压并发症。只有当药物治疗的依从性约为50%或更低（大多数患者群体建议的比率）时，对高血压性肾血管疾病的识别和手术治疗才会比单纯的盲目抗高血压药物治疗在发病率方面带来额外益处。该研究强调了诊断和治疗程序的定量疗效不仅取决于其内在风险和益处，还取决于相关社会和医学因素的程度。
