Thomson R, Greenaway J, Chinn D J, Wood R, Rodgers H
School of Population and Health Sciences (Epidemiology and Public Health) Medical School, Framlington Place, University of Newcastle upon Tyne, Newcastle upon Tyne, UK.
J Hum Hypertens. 2005 Sep;19(9):683-9. doi: 10.1038/sj.jhh.1001896.
Recently revised UK and US hypertension guidelines have reduced thresholds for both diagnosis and treatment and differ in their recommendations. We have used data from a random, stratified community-based sample of 4784 people aged 65 years and over to compare the prevalence of treatable hypertension and the potential impact on patients and primary care from using current guidelines. BHS, NICE and JNC7 guidelines were applied to blood pressures obtained from primary care medical records (94%) or measured at a screening clinic (6%). Risk factors were obtained by questionnaire and from medical records, supplemented by epidemiological data. Workload was estimated for a representative practice population of 10 000 patients. Blood pressures were obtained on 4514 patients (94%). Prevalence of treatable hypertension was over 67%. Compared to BHS4, prevalence estimates using NICE guidelines were comparable for men but significantly lower for women (P<0.05). They were significantly higher using JNC7 compared with BHS4 and NICE guidance (P<0.05). A general practice of 10 000 patients could expect 1287 older hypertensive patients using BHS4 guidelines and 1231 patients using NICE guidelines. Under BHS4, an extra 94 patients will require annual, rather than 5-yearly review compared with that using the previous guideline. In conclusion, implementation of BHS4 guidelines, with their revised thresholds for diagnosis, will not add materially to the prevalence of treatable hypertension compared to previous BHS3 guidelines but will have a major impact on practice workload. Use of NICE guidelines in preference to BHS4 will result in GPs treating fewer patients and reviewing untreated patients less often.
最近修订的英国和美国高血压指南降低了诊断和治疗的阈值，且建议有所不同。我们使用了来自一个基于社区的随机分层样本的数据，该样本包含4784名65岁及以上的人群，以比较可治疗高血压的患病率以及采用当前指南对患者和初级保健的潜在影响。将英国高血压协会（BHS）、英国国家卫生与临床优化研究所（NICE）和美国国家联合委员会第7版（JNC7）指南应用于从初级保健医疗记录中获取的血压数据（94%）或在筛查诊所测量的血压数据（6%）。通过问卷调查和医疗记录获取风险因素，并辅以流行病学数据。对一个有10000名患者的代表性执业人群的工作量进行了估算。4514名患者（94%）获取了血压数据。可治疗高血压的患病率超过67%。与BHS4相比，使用NICE指南估算的男性患病率相当，但女性患病率显著更低（P<0.05）。与BHS4和NICE指南相比，使用JNC7估算的患病率显著更高（P<0.05）。一个有10000名患者的全科诊所，按照BHS4指南预计有1287名老年高血压患者，按照NICE指南预计有1231名患者。与使用先前指南相比，按照BHS4，额外有94名患者需要每年而非每5年进行一次复查。总之，与先前的BHS3指南相比，实施诊断阈值有所修订的BHS4指南不会显著增加可治疗高血压的患病率，但会对执业工作量产生重大影响。优先使用NICE指南而非BHS4将导致全科医生治疗的患者更少，且对未治疗患者的复查频率更低。
