Menard J, Chatellier G, Degoulet P, Plouin P F, Corvol P
Hypertension. 1983 Sep-Oct;5(5 Pt 2):III21-5. doi: 10.1161/01.hyp.5.5_pt_2.iii21.
Whatever the therapeutic goal proposed for diastolic blood pressure in hypertensive patients, the actual results of treatment in various health care delivery systems throughout the world are not as good as generally assumed. In the two recent controlled therapeutic trials, 24.5% (Australian trial) and 29.9% (Hypertension Detection and Follow-up Program) of actively treated patients had diastolic blood pressure levels above 90 mm Hg. In three British hospital clinics, diastolic blood pressure was greater than 90 mm Hg in 69% of the treated patients after 6 months to 1 year of treatment. In our own clinic, the blood pressure of 947 hypertensive patients registered in the Artemis system (Paris) between 1976 to 1980 decreased after 2 years on medical treatment from 177/108 to 142/87 mm Hg. However 21.1% of the patients studied still had a diastolic blood pressure above 95 mm Hg. In the general population, the percentage of treated patients not attaining goal levels varies from 42.9% to 71%. Not only is it important to agree upon goals, but it is urgent to standardize methods for collecting and analyzing the results of antihypertensive treatments in various health care delivery systems, since high rates of therapeutic failures might be related to the physician's strategy, the patient's characteristics, the disease's particularities, and the limited efficacy and side-effects of presently available drugs.
无论为高血压患者的舒张压设定何种治疗目标，全球各类医疗保健体系中的实际治疗效果都不如普遍认为的那样理想。在最近的两项对照治疗试验中，积极治疗的患者中有24.5%（澳大利亚试验）和29.9%（高血压检测与随访项目）的舒张压水平高于90毫米汞柱。在英国的三家医院诊所，经过6个月至1年的治疗后，69%的接受治疗患者的舒张压高于90毫米汞柱。在我们自己的诊所，1976年至1980年在阿耳忒弥斯系统（巴黎）登记的947名高血压患者，经过2年药物治疗后，血压从177/108毫米汞柱降至142/87毫米汞柱。然而，所研究的患者中有21.1%的舒张压仍高于95毫米汞柱。在普通人群中，未达到目标水平的接受治疗患者的比例在42.9%至71%之间。不仅就目标达成共识很重要，而且迫切需要规范各类医疗保健体系中抗高血压治疗结果的收集和分析方法，因为高治疗失败率可能与医生的策略、患者的特征、疾病的特殊性以及当前可用药物有限的疗效和副作用有关。
