McAlister F A, Teo K K, Lewanczuk R Z, Wells G, Montague T J
Division of General Internal Medicine, University of Alberta, Edmonton.
CMAJ. 1997 Jul 1;157(1):23-30.
To determine what proportion of patients with hypertension are managed in accordance with guidelines established by the Canadian Hypertension Society.
Retrospective medical record review.
Outpatients seen in primary care offices and internal medicine referral clinics in Edmonton.
All 969 adults who presented with a new diagnosis of essential hypertension from Sept. 1, 1993, to Dec. 31, 1995.
Initial laboratory tests performed, advice concerning nonpharmacologic treatment given, antihypertensive drugs prescribed and any contraindications to thiazide diuretics or beta-adrenergic blocking agents documented.
The mean age of the 969 patients in the sample was 52.5 years; 129 (13%) of the patients were older than 70 years of age; and 500 (52%) were women. Most of the patients (704, 73%) had mild or moderate diastolic hypertension. In the 617 patients who underwent laboratory tests related to hypertension, the creatinine level was determined in 466 (76%), the cholesterol level in 372 (60%), a urinalysis was conducted in 378 (61%), the serum potassium level was checked in 343 (56%), the sodium level in 323 (52%) and an electrocardiogram was performed in 303 (49%). Liver function tests, which are not recommended in the guidelines, were performed in 338 patients (55%). Although there were differences in prescribing among physicians in the 711 patients given first-line therapy, most (238, 34%) were prescribed angiotensin-converting-enzyme (ACE) inhibitors. Lifestyle modification, without drug therapy, was suggested for 180 (25%) of the patients. Although the guidelines recommend their use for first-line drug therapy, only 82 patients (12%) were given beta-adrenergic blocking agents and only 75 (11%) were given thiazide diuretics. Of the patients who were prescribed an antihypertensive other than a thiazide or beta-adrenergic blocking agent as first-line drug therapy, only 161 (43%) had a documented contraindication to thiazides or beta-adrenergic blocking agents.
There is variation in the contemporary care of patients with hypertension. Further studies are required to determine the reasons underlying physicians' noncompliance with the evidence-based guidelines established by the Canadian Hypertension Society.
确定按照加拿大高血压协会制定的指南管理的高血压患者比例。
回顾性病历审查。
埃德蒙顿初级保健办公室和内科转诊诊所的门诊患者。
1993年9月1日至1995年12月31日期间新诊断为原发性高血压的所有969名成年人。
进行的初始实验室检查、给予的非药物治疗建议、开具的抗高血压药物以及记录的噻嗪类利尿剂或β-肾上腺素能阻滞剂的任何禁忌症。
样本中969名患者的平均年龄为52.5岁；129名（13%）患者年龄超过70岁；500名（52%）为女性。大多数患者（704名，73%）患有轻度或中度舒张期高血压。在617名接受与高血压相关实验室检查的患者中，466名（76%）测定了肌酐水平，372名（60%）测定了胆固醇水平，378名（61%）进行了尿液分析，343名（56%）检查了血清钾水平，323名（52%）检查了钠水平，303名（49%）进行了心电图检查。338名患者（55%）进行了指南中不推荐的肝功能检查。在接受一线治疗的711名患者中，尽管医生的处方存在差异，但大多数（238名，34%）患者被开具了血管紧张素转换酶（ACE）抑制剂。180名（25%）患者被建议进行生活方式改变而不进行药物治疗。尽管指南推荐将其用于一线药物治疗，但只有82名患者（12%）被给予β-肾上腺素能阻滞剂，只有75名（11%）被给予噻嗪类利尿剂。在作为一线药物治疗被开具除噻嗪类或β-肾上腺素能阻滞剂以外的抗高血压药物的患者中，只有161名（43%）有记录的噻嗪类或β-肾上腺素能阻滞剂禁忌症。
高血压患者的当代护理存在差异。需要进一步研究以确定医生不遵守加拿大高血压协会制定的循证指南的原因。
