根據一份在八月十六日The New England Journal of Medicine上新的研究顯示，不到四分之一的患有高血壓病人接受藥物控制病情。該作者指出，高血壓影響將近四分之一的美國人，其治療是醫師的職責中最常見之一，然而，大多數患有輕微、單獨收縮壓高血壓的病患卻沒有接受適當的治療。主筆者David J. Hyman, MD, MPH,告訴WebMD：「許多醫師很顯然地並沒有讓患有輕微高血壓的患者接受治療，如那些收縮壓在140-160mmHg的病人。」
Less Than a Quarter of Hypertensives Receive Adequate Treatment
Physicians Still Neglecting to Treat Mild Hypertension
By Aman Shah, MD
WebMD Medical News
Reviewed by Michael W. Smith, MD
Aug. 16, 2001 -- Less than 25% of people with high blood pressure take medication to control the condition, according to a study in the Aug. 16 issue of The New England Journal of Medicine. The authors point out that hypertension, which affects about a quarter of the U.S. population, is one of the most common treatment responsibilities for physicians, and yet it appears that most patients with mild, isolated systolic hypertension are not receiving adequate treatment.
Many physicians are apparently not treating people with mild hypertension, such as those with systolics in the 140-160 mmHg range, lead author David J. Hyman, MD, MPH, tells WebMD.
Hyman, associate professor of medicine at Baylor College of Medicine in Houston, and colleague Valory Pavlik, PhD, examined data from the third National Health and Nutrition Examination Survey. They found that 27% of the more than 16,000 people in the survey had hypertension (blood pressure over 140/90 mmHg or use of antihypertensives), but only 23% of those were on antihypertensives.
Most patients with untreated hypertension had an elevated systolic pressure with a diastolic under 90 mmHg. Patients aged 65 or older, males, and blacks were less likely to be aware of their hypertension. Interestingly, most patients with uncontrolled hypertension had health insurance and regular contact with a physician.
Hyman speculates that some older physicians may not have incorporated the newer guidelines and may still consider a systolic pressure of "100 mmHg + age" to be normal. Others may feel that the benefits of treating mildly elevated systolic pressure have not been conclusively shown.
"I suspect the general problem still exists," says Aram V. Chobanian, MD. "We still are not doing great."
Chobanian agrees that some physicians may be hesitant to intervene at times because they feel there aren't enough data to justify very aggressive treatment in people with systolic pressures between 140 and 160.
"On the other hand, the evidence is that total cardiovascular risk is what's important, and whatever you can do to reduce total cardiovascular risk should be justified," he says. "Most of these individuals, the vast, vast majority, don't have problems from lowering their blood pressure. This had been a grave concern to the medical community."
The problem, he says, is that large studies showing benefits of reducing mildly high blood pressure have not been carried out, despite good evidence to suggest it is important. Chobanian, dean of the school of medicine at Boston University, says treatment is definitely justified if someone has diabetes or has already had a stroke, MI, or heart failure.
"The majority of people with systolic hypertension who are older fall into a category where they would deserve treatment because of other risk factors," he says.