Troein M, Arneson T, Råstam L, Pirie P L, Selander S, Luepker R V
Department of Community Medicine, Lund University, Malmö, Sweden.
J Intern Med. 1995 Sep;238(3):215-21. doi: 10.1111/j.1365-2796.1995.tb00925.x.
To compare family physicians' reported practice habits on hypertension in Sweden and Minnesota, and to assess to what extent different national guidelines account for differences.
Random samples of family physicians were selected for telephone interviews on their practice of hypertension.
Primary care in southern Sweden and in Minnesota.
Family medicine specialists. Participation rates were 236/264 (89%) in Sweden and 183/209 (88%) in Minnesota.
Cut-off levels, and non-pharmacological and pharmacological treatment of hypertension, related to three case scenarios: a 48-year-old man, a 65-year-old man and a 65-year-old woman.
Swedish physicians reported significantly higher levels of diastolic blood pressure than Minnesota physicians for the institution of treatment of hypertension for all case scenarios. In both countries, physicians adhered to the cut-off levels of their national guidelines in the case of the 48-year-old man. Minnesota physicians did not use age as a modifying factor for treatment cut-off levels, as did Swedish physicians. Swedish physicians emphasized alcohol, fat and stress reduction, and Minnesota physicians weight and salt reduction as non-pharmacological treatment. While Swedish physicians generally preferred beta-blockers, Minnesota physicians chose ACE inhibitors or calcium channel blockers as the first choice drug.
Swedish and US guidelines on hypertension were identical except for higher cut-off level for drug treatment in Sweden. Minnesota physicians reported cut-off levels close to national guidelines. For 65-year-old patients, Swedish physicians reported applying a higher cut-off level than indicated by guidelines. Swedish physicians also reported preferring less expensive drugs. As a consequence of the differing national guidelines and the identified physicians' practice habits in the two medical communities, it is likely that the segments of the populations treated and the drug costs differ substantially.
比较瑞典和明尼苏达州家庭医生报告的高血压治疗习惯，并评估不同国家指南对差异的解释程度。
选取家庭医生随机样本进行关于高血压治疗的电话访谈。
瑞典南部和明尼苏达州的初级医疗。
家庭医学专家。瑞典的参与率为236/264（89%），明尼苏达州为183/209（88%）。
与三种病例情况相关的高血压临界值、非药物治疗和药物治疗，这三种病例情况分别为一名48岁男性、一名65岁男性和一名65岁女性。
在所有病例情况中，瑞典医生报告的高血压治疗起始舒张压水平显著高于明尼苏达州医生。在两国，对于48岁男性病例，医生均遵循本国指南的临界值。明尼苏达州医生不像瑞典医生那样将年龄作为治疗临界值的调整因素。瑞典医生强调减少酒精、脂肪摄入和减轻压力，而明尼苏达州医生则强调减轻体重和减少盐摄入作为非药物治疗方法。瑞典医生一般更倾向于使用β受体阻滞剂，而明尼苏达州医生则选择血管紧张素转换酶抑制剂或钙通道阻滞剂作为首选药物。
瑞典和美国的高血压指南除了瑞典药物治疗的临界值较高外基本相同。明尼苏达州医生报告的临界值接近国家指南。对于65岁的患者，瑞典医生报告的临界值高于指南所示。瑞典医生还报告更喜欢使用较便宜的药物。由于两个医疗群体中不同的国家指南和已确定的医生治疗习惯，接受治疗的人群比例和药物成本可能存在很大差异。
