Haynes R B, Gibson E S, Taylor D W, Bernholz C D, Sackett D L
Circulation. 1982 Jan;65(1):28-33. doi: 10.1161/01.cir.65.1.28.
We studied the association between the outcome of antihypertensive care and three items of that care among 230 hypertensive steelworkers who were referred to 83 physicians. The first item was the decision to treat some patients but not others: 63% of the patients were prescribed antihypertensive drugs and the mean decrease in their diastolic blood pressure (DBP) was greater than that among untreated patients (12.2 +/- 0.84 vs 7.8 +/- 0.83 mm Hg [+/- SEM], p less than 0.001). The second item was the vigor of prescribed medication: Patients prescribed more vigorous treatments had lower DBP (p less than 0.005). Third, patient compliance was related to achieving a goal DBP of less than 90 mm Hg (p less than 0.05) and the product of prescribed vigor and compliance was highly associated with DBP response (p less than 0.0001). These results stand in contrast to those of previous studies that failed to detect associations between various other items of the care process and the outcome of antihypertensive care.
我们研究了230名被转诊至83位医生处的高血压钢铁工人的降压治疗结果与三项治疗措施之间的关联。第一项措施是决定对部分患者进行治疗而不对其他患者进行治疗：63%的患者被开了降压药，他们的舒张压（DBP）平均降幅大于未治疗患者（12.2±0.84 vs 7.8±0.83 mmHg [±SEM]，p<0.001）。第二项措施是所开药物治疗的力度：接受更强力治疗的患者DBP较低（p<0.005）。第三，患者的依从性与实现DBP目标值低于90 mmHg相关（p<0.05），且所开药物治疗力度与依从性的乘积与DBP反应高度相关（p<0.0001）。这些结果与之前的研究结果形成对比，之前的研究未能发现治疗过程中的其他各项措施与降压治疗结果之间存在关联。
