Krabbe Tyge, Drivsholm Thomas
Almen Medicinsk Forskningsenhed i Frederiksborg Amt og Forskningsenheden for Almen Praksis i København.
Ugeskr Laeger. 2006 Oct 9;168(41):3526-30.
This study examined the changes in detection and treatment of hypertension in a rural general practice after the introduction of new guidelines for treatment of hypertension published in 1999 by the Danish Hypertension Society.
Data from all patients in practice diagnosed with hypertension on 1 October 1998 were registered (n = 200). By 1 October 2003, 28 patients had left the cohort due to death (n = 26) or moving to other parts of the country (n = 2). For the remaining 172 patients, the blood pressure in 1998 and 2003 was found in the case record. The results of physical examinations, risk factors, morbidity rates and treatment were registered.
In 1998, the average blood pressure in the study cohort was 157/89 mmHg. By 2003, it had fallen to 141/84 mmHg. The difference in both systolic and diastolic blood pressure was statistically significant (p < 0.001). In 1998, 27 percent of the hypertensive patients in the cohort had reached the target value (< or = 140/90 mmHg). This percentage rose to 55 percent in 2003. The pattern of examinations concerning tracking down risk factors was markedly altered in the period. Pharmacological treatment had substantially increased during the period, with many more patients being treated with more than one drug.
This study indicates that the introduction of new guidelines has caused considerable changes in the detection, risk evaluation and treatment of hypertension.
本研究调查了丹麦高血压协会1999年发布高血压新治疗指南后，某乡村全科医疗中高血压检测与治疗的变化情况。
记录了1998年10月1日在该医疗机构确诊为高血压的所有患者的数据（n = 200）。到2003年10月1日，28名患者因死亡（n = 26）或搬至该国其他地区（n = 2）而退出队列。对于其余172名患者，在病历中找到了他们1998年和2003年的血压值。记录了体格检查结果、危险因素、发病率和治疗情况。
1998年，研究队列中的平均血压为157/89 mmHg。到2003年，已降至141/84 mmHg。收缩压和舒张压的差异均具有统计学意义（p < 0.001）。1998年，队列中27%的高血压患者达到了目标值（≤140/90 mmHg）。2003年这一比例升至55%。在此期间，追踪危险因素的检查模式发生了显著变化。在此期间，药物治疗大幅增加，更多患者使用不止一种药物进行治疗。
本研究表明，新指南的引入在高血压的检测、风险评估和治疗方面引起了相当大的变化。
