Stason W B
Am J Med. 1986 Dec 31;81(6C):45-9. doi: 10.1016/0002-9343(86)90528-0.
Hypertension is an extremely important public health problem, both medically and economically. The cost burden of treatment may significantly compromise care for the individual patient, while in aggregate the direct costs of antihypertensive treatment in the United States approach $8 billion a year. Improved insurance coverage and efforts to control the costs of antihypertensive treatment are needed. Efforts to reduce the costs of care, with minimal or no reduction in its quality, should focus on the following: limiting treatment to patients with sustained diastolic hypertension; improving the efficiency of the delivery process; and emphasizing "low-cost prescribing strategies." The uncertainty that remains over the risk-benefit ratio of pharmacologic treatment for patients with very mild hypertension (90 to 94 mm Hg diastolic) raises additional questions. Even if treatment of mild hypertension is effective, it is without doubt less cost-effective than treatment of moderate and severe hypertension. Is this cost worthwhile? Such trade-offs of cost and benefits will increasingly have to be confronted in the face of limited health care resources.
高血压在医学和经济方面都是极其重要的公共卫生问题。治疗的成本负担可能会严重影响对个体患者的护理，而在美国，抗高血压治疗的直接成本总计每年接近80亿美元。需要改善保险覆盖范围并努力控制抗高血压治疗的成本。在尽量减少或不降低护理质量的情况下降低护理成本的努力应集中在以下方面：将治疗限制在持续性舒张压高血压患者；提高治疗过程的效率；强调“低成本处方策略”。对于轻度高血压（舒张压90至94毫米汞柱）患者，药物治疗的风险效益比仍存在不确定性，这引发了更多问题。即使轻度高血压的治疗有效，毫无疑问，其成本效益也低于中度和重度高血压的治疗。这种成本是否值得？面对有限的医疗资源，这种成本与效益的权衡将越来越需要面对。
