Poggi L, Chamontin B, Lang T, Menard J, Chevalier H, Gallois H, Cremier O
Service de médecine interne, CHU Timone, Marseille.
Arch Mal Coeur Vaiss. 1996 Aug;89(8):1075-80.
The aim of this study was to measure the percentage of patients with hypertension, treated hypertension and controlled hypertension, using data collected over one week by 235 general practitioners well representative of the French medical population and selected by SOFRES Médical. Practitioners had to carry out their own survey over a period of one week on all patients above 18 years of age who visited their office. They were initially instructed to use the same type of mercury sphygmomanometer, equiped with the same pneumatic cuffs of different sizes. Three consecutive blood pressure measurements were effected, the last two were recorded. Patients were considered as hypertensive if the mean of the two recorded BP measurements was > or = 140-90 mmHg, or < 140-90 mmHg under pharmacological treatment. Hypertensive patients were considered as controlled when their blood pressure levels were overall < 140-90 mmHg under treatment. According to age, two other control levels were analysed: blood pressure < 160-95 mmHg before 65 years and blood pressure < 160-90 mmHg at 65 years or more. Among 12,351 patients, 5,020 are hypertensive (4%), 2,985 under pharmacological treatment (59%) and 2,035 without treatment (4%). Among untreated patients, 9% had an hypertension above the borderline values. Before 65 years, 28% had an under treatment blood pressure < 140-90 mmHg and 71% < 160-95 mmHg. Among 65 years or more hypertensive patients, 21% had an under treatment blood pressure < 140-90 mmHg and 60% < 160-90 mmHg. Before 65 years, 25% among patients with a monotherapy remained with a blood pressure > 160-95 mmHg and 34% with a blood pressure > 160-90 mmHg among those of 65 years or more; 230 patients (5%) remained in high risk with a blood pressure > 180-105 mmHg. 176 untreated and 54 despite their treatment. This study carried out in French medical practice yield two main conclusions regarding the management of hypertension: as the prevalence of hypertensive patients is 41%: one patient out of two, high blood pressure has to be a main aim for the medical teaching. Even if a reasonable control of the blood pressure is achieved in most cases, blood pressure got a normal level for 24% only of treated hypertensive patients and too many patients were keeping high risk because they have been not or not enough treated. This study, as a real audit, gives some useful informations to general practitioners in order to improve their scores.
本研究的目的是利用由235名全科医生在一周内收集的数据来测量高血压患者、接受治疗的高血压患者和血压得到控制的高血压患者的比例。这些全科医生具有法国医学人群的充分代表性，由索福瑞医疗公司（SOFRES Médical）挑选。医生们必须在一周时间内，对所有前来就诊的18岁以上患者进行自己的调查。他们最初被指示使用同一类型的汞柱式血压计，并配备相同的不同尺寸的气袖带。进行了连续三次血压测量，记录后两次测量结果。如果两次记录的血压测量平均值≥140/90 mmHg，或者在药物治疗下＜140/90 mmHg，则患者被视为高血压患者。当高血压患者在治疗期间血压总体＜140/90 mmHg时，被视为血压得到控制。根据年龄，还分析了另外两个控制水平：65岁之前血压＜160/95 mmHg，65岁及以上血压＜160/90 mmHg。在12351名患者中，5020名患有高血压（4%），2985名正在接受药物治疗（59%），2035名未接受治疗（4%）。在未接受治疗的患者中，9%的人血压高于临界值。65岁之前，28%接受治疗的患者血压＜140/90 mmHg，71%＜160/95 mmHg。在65岁及以上的高血压患者中，21%接受治疗的患者血压＜140/90 mmHg，60%＜160/90 mmHg。65岁之前，接受单一疗法的患者中有25%血压＞160/95 mmHg，65岁及以上的患者中有34%血压＞160/90 mmHg；230名患者（5%）血压＞180/105 mmHg，仍处于高风险状态，其中176名未接受治疗，54名尽管接受了治疗。这项在法国医疗实践中开展的研究在高血压管理方面得出了两个主要结论：由于高血压患者的患病率为41%，即每两名患者中就有一名，高血压必须成为医学教学的主要目标。即使在大多数情况下血压得到了合理控制，但仅24%接受治疗的高血压患者血压达到了正常水平，而且有太多患者因未接受治疗或治疗不足而仍处于高风险状态。这项研究作为一次实际审计，为全科医生提供了一些有用信息，以提高他们的工作成绩。
