Smith T D, Clayton D
Department of Community Health, Leicester Royal Infirmary.
BMJ. 1990 Jan 13;300(6717):74-5. doi: 10.1136/bmj.300.6717.74.
Variation in labelling of hypertension by individual general practitioners was studied during a continuous opportunistic screening programme for hypertension in a single general practice with 12 principals. All the general practitioners agreed to label as hypertensive patients with systolic pressures of greater than or equal to 200 mm Hg or diastolic pressures of greater than or equal to 110 mm Hg on three consecutive readings. The overall number of patients labelled hypertensive at the beginning of the screening programme was 505 and this rose to 801 after five years. There was a large variation in the numbers of patients recorded as hypertensive at the start of the screening period, with numbers ranging from eight to 112 for individual practitioners. The variation persisted during the screening period, with the numbers of patients detected by individual general practitioners ranging from four to 46. The average systolic and diastolic pressures recorded among these patients also varied between doctors, and only 24 out of 187 patients had their high pressures recorded on three occasions and so fully met the criteria for diagnosing hypertension. Clearly, general practitioners are following their own individual criteria in defining hypertension and taking into account factors other than just the measured blood pressure.
在一项针对一家拥有12名负责人的单一全科诊所开展的持续性机会性高血压筛查项目中，研究了个体全科医生对高血压的诊断差异。所有全科医生都同意，连续三次测量收缩压大于或等于200毫米汞柱或舒张压大于或等于110毫米汞柱的患者应被诊断为高血压患者。筛查项目开始时被诊断为高血压的患者总数为505人，五年后增至801人。筛查期开始时，记录为高血压患者的数量存在很大差异，个体医生记录的患者数量从8人到112人不等。这种差异在筛查期间持续存在，个体全科医生检测出的患者数量从4人到46人不等。这些患者的平均收缩压和舒张压在不同医生之间也有所不同，187名患者中只有24人三次测量出高血压，因此完全符合高血压诊断标准。显然，全科医生在定义高血压时遵循自己的个人标准，并考虑了除测量血压之外的其他因素。
