Mant D, McKinlay C, Fuller A, Randall T, Fullard E M, Muir J
Imperial Cancer Research Fund General Practice Research Group, Radcliffe Infirmary, Oxford.
BMJ. 1989 May 20;298(6684):1360-2. doi: 10.1136/bmj.298.6684.1360.
To assess the extent of three year follow up of blood pressure, weight, and smoking habit in patients with raised blood pressure identified at health checks.
Retrospective audit of medical and nursing records.
Three general practices in Oxfordshire.
386 of 448 patients with raised blood pressure (diastolic greater than or equal to 90 or systolic greater than or equal to 160 mm Hg) identified from 2935 patients aged 35-64 attending health checks in 1982-4.
All records of blood pressure, weight, and smoking habit in the medical record were abstracted for three years after the initial health check. All 42 patients with an initial diastolic blood pressure greater than or equal to 105 mm Hg and 316 of 344 patients with an initial pressure of 90-104 mm Hg had at least one further measurement of their blood pressure. Follow up of smoking habit and of weight was less complete with only half of the 100 smokers and 67 of the 87 obese patients (body mass index greater than or equal to 30) having any documented follow up of these risk factors. Annual follow up in the second and third years occurred in 228/297 (76.8%) and 232/320 (72.5%) in patients with blood pressure greater than 95 mm Hg at the beginning of each year. For patients who smoked annual follow up in these years occurred in fewer than a third and for those who were obese in just over half. On the assumption that those not followed up had not changed, at the end of three years the proportion of patients with diastolic blood pressure greater than or equal to 100 mm Hg had fallen from 61 patients (15.8%) to 31 (8.1%); the proportion of smokers had fallen from 103 (26.7%) to 94 (24.4%); and the proportion of obese patients had fallen from 87 (22.5%) to 79 (20.5%).
These changes were modest and in the absence of a control group cannot be attributed necessarily to health checks. Although the standard of follow up was better than in previously reported studies of the management of hypertension, the results emphasise the need to develop formal protocols for dietary and antismoking interventions and to evaluate formally the effectiveness (and cost effectiveness) of health checks.
评估对健康检查中发现的血压升高患者进行三年血压、体重及吸烟习惯随访的情况。
对医疗和护理记录进行回顾性审计。
牛津郡的三家普通诊所。
从1982 - 1984年接受健康检查的2935名35 - 64岁患者中识别出448名血压升高患者（舒张压大于或等于90mmHg或收缩压大于或等于160mmHg），其中386名纳入研究。
在首次健康检查后的三年里，提取病历中所有关于血压、体重及吸烟习惯的记录。所有42名初始舒张压大于或等于105mmHg的患者以及344名初始血压为90 - 104mmHg患者中的316名至少进行了一次血压复测。对吸烟习惯和体重的随访不太完整，100名吸烟者中只有一半、87名肥胖患者（体重指数大于或等于30）中只有67名有这些危险因素的任何记录随访。每年年初血压大于95mmHg的患者中，第二年和第三年的年度随访率分别为228/297（76.8%）和232/320（72.5%）。对于吸烟患者，这些年份的年度随访率不到三分之一，对于肥胖患者则略超过一半。假设未接受随访的患者情况未改变，三年结束时，舒张压大于或等于100mmHg的患者比例从61名（15.8%）降至31名（8.1%）；吸烟者比例从103名（26.7%）降至94名（24.4%）；肥胖患者比例从87名（22.5%）降至79名（20.5%）。
这些变化不大，且在没有对照组的情况下，不一定能归因于健康检查。尽管随访标准比先前报道的高血压管理研究更好，但结果强调需要制定饮食和戒烟干预的正式方案，并正式评估健康检查的有效性（和成本效益）。
