Follow up of hypertension by family practitioners
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《英国医生杂志》
EDITOR—The subjects of the study had hypertension in control at entry. We don't think this affects the generalisability of the study in relation to patients with known hypertension who attend their doctor, since hypertension in about 20% of these patients was out of control at some time during the study. The study is not generalisable to all people with hypertension.
We agree with Nelson that a patient's cardiovascular risk should be viewed in total. Sometimes patients need to be seen more often because of other risk factors such as diabetes. The reality is that doctors see patients for "a blood pressure check," and we showed that doing this every six months is equivalent to every three months. What else is discussed at the visit is being presented in another paper.
Barnes notes that our outcomes are not the ones he would have chosen. We agree that outcomes such as stroke and death are the ultimate measures of success, but for this type of study large numbers of patients would need to be followed up over many years. The outcomes we used provide some approximation to these definitive outcomes. Given our results, we think that visiting the doctor every six months is satisfactory for the types of patients we studied.
Blood pressure measurement is a different matter, and having patients take control and measure their own blood pressure between visits may be desirable.
We agree with Nelson that a patient's cardiovascular risk should be viewed in total. Sometimes patients need to be seen more often because of other risk factors such as diabetes. The reality is that doctors see patients for "a blood pressure check," and we showed that doing this every six months is equivalent to every three months. What else is discussed at the visit is being presented in another paper.
Barnes notes that our outcomes are not the ones he would have chosen. We agree that outcomes such as stroke and death are the ultimate measures of success, but for this type of study large numbers of patients would need to be followed up over many years. The outcomes we used provide some approximation to these definitive outcomes. Given our results, we think that visiting the doctor every six months is satisfactory for the types of patients we studied.
Blood pressure measurement is a different matter, and having patients take control and measure their own blood pressure between visits may be desirable.