This report examines the systemic challenges associated with hypertension management globally and specifically within South Africa, emphasizing the gap between diagnosis and clinical control.

本報告探討全球以及南非在高血壓管理方面面臨的系統性挑戰，並強調診斷與臨床控制之間的差距。

Global epidemiological data indicates a significant disparity in hypertension burden between high-income and low-to-middle-income countries (LMICs). As of 2020, approximately 1.71 billion adults worldwide were affected, with 83% of uncontrolled cases situated in LMICs. While high-income nations observed a control rate of 40.2% by 2020, LMICs achieved only 13.6%, reflecting a systemic failure in the implementation of chronic disease management strategies. The highest prevalence rates were identified in sub-Saharan Africa, Latin America, and the Caribbean.

全球流行病學數據顯示，高收入國家與中低收入國家 (LMICs) 在高血壓負擔方面存在顯著差異。截至 2020 年，全球約有 17.1 億成年人受影響，其中 83% 的未控制病例位於中低收入國家。雖然高收入國家在 2020 年的控制率為 40.2%，但中低收入國家僅達到 13.6%，反映出慢性病管理策略在執行上的系統性失敗。最高盛行率分布在撒哈拉以南非洲、拉丁美洲及加勒比地區。

Within the South African context, the transition from diagnosis to effective blood pressure regulation remains suboptimal. Although control rates among newly diagnosed patients increased from 7.1% in 2011 to 22.1% in 2017, a 2023 study in Johannesburg revealed that 57% of outpatients remained uncontrolled despite receiving care. This phenomenon, characterized by experts as 'treatment inertia,' suggests a failure to adjust therapeutic regimens when initial interventions prove insufficient. The efficacy of clinical outcomes is further compromised by the inconsistent application of primary care guidelines and the complexity of treatment protocols.

在南非的背景下，從診斷到有效血壓調節的轉化仍然不理想。儘管新診斷患者的控制率從 2011 年的 7.1% 增加到 2017 年的 22.1%，但 2023 年在約翰內斯堡的一項研究顯示，57% 的門診患者儘管接受治療，血壓仍未受控制。專家將此現象稱為「治療慣性」，顯示在初步干預不足時，未能調整治療方案。由於基層醫療指南應用不一致以及治療方案複雜，進一步損害了臨床結果的成效。

Stakeholder analysis suggests that poor control is not solely a consequence of patient non-compliance but is exacerbated by structural determinants. Socioeconomic variables—including the cost of nutritious food, transport limitations, and overburdened healthcare infrastructure—impede the sustainability of lifestyle modifications and medication adherence. Consequently, there is a proposed shift toward simplified treatment modalities, such as fixed-dose combinations, to enhance adherence and reduce the cognitive and financial burden on the patient population.

利益相關者分析顯示，控制不佳不僅僅是患者不依從治療導致的，更是由結構性因素加劇。社會經濟變數——包括營養食物的成本、交通限制以及不堪負荷的醫療基礎設施——阻礙了生活方式改變和藥物依從性的可持續性。因此，建議轉向簡化的治療模式，例如固定劑量組合藥，以提高依從性並減輕患者群體的認知與經濟負擔。

Hypertension remains a critical driver of morbidity and mortality, requiring a transition from mere awareness to a rigorous, system-wide focus on long-term clinical control.

高血壓仍是導致發病率與死亡率增加的關鍵因素，需要從僅僅提高意識，轉向在全系統範圍內嚴格關注長期臨床控制。