Tanaka Reiichiro, Okawa Motohisa, Ujike Yoshihito
1Department of Emergency Medicine,Institute of Neuroscience and Orthopedics,Okayama Kyokuto Hospital,Okayama,Japan.
2Department of Health Science,College of Life Science,Kurashiki University of Science and the Arts,Okayama,Japan.
Prehosp Disaster Med. 2016 Feb;31(1):17-26. doi: 10.1017/S1049023X15005440. Epub 2016 Jan 26.
Many survivors of a major disaster die shortly after the event. Hypertension (HT) is one of the most important risk factors for these disaster-related diseases. An urgent need exists to establish methods to detect disaster survivors with HT and start medication immediately, as those with no injuries or symptoms may not be examined and medical teams cannot measure all survivors' blood pressure (BP) because they often do not have sufficient time.
The goals of this report were: (1) to evaluate the importance of taking antihypertensive drugs continuously for patients with HT during the sub-acute phase after a major earthquake, when patients cannot attend a clinic because of destruction of the local infrastructure; and (2) to establish simple and reliable predictors to detect evacuees with HT, who require clinical examination and treatment at evacuation shelters or in their homes after a major earthquake.
Medical rounds were performed at evacuation shelters in Iwate Prefecture after the Great East Japan Earthquake. Forty evacuees were enrolled in a cross-sectional study. The effect of taking antihypertensive drugs continuously was evaluated and predictors of HT in evacuees were identified using multiple logistic regression analysis.
Twenty-eight evacuees were hypertensive (70%), nine of whom were asymptomatic (32%). Most evacuees who had discontinued antihypertensive medication (92%; 11/12) had very high BP, while those who had continued antihypertensive medication (80%; 8/10) were mildly hypertensive. The systolic BP of those who had discontinued antihypertensive drugs was significantly higher than that of those who had continued hypertensive drugs in the whole cohort (n=40), and also in evacuees diagnosed as having HT at evacuation shelters (n=28; P55 years (aOR, 1.10; 95% CI, 1.01-1.21) predicted HT with a sensitivity of 0.96 and specificity of 0.80.
The results of this study suggest that continuity of antihypertensive medication prevents serious HT at evacuation shelters in the first 10 days after a major earthquake. Onsite medical rounds focusing on simple predictors in an early stage after disasters may be an effective means of detecting and treating hypertensive disaster victims before they succumb to a fatal disease.
许多重大灾难的幸存者在灾难发生后不久便会死亡。高血压（HT）是这些与灾难相关疾病的最重要风险因素之一。迫切需要建立检测患有高血压的灾难幸存者并立即开始用药的方法，因为那些没有受伤或症状的人可能不会接受检查，而且医疗团队没有足够时间为所有幸存者测量血压（BP）。
本报告的目标是：（1）评估在大地震后的亚急性期，当地基础设施遭到破坏，患者无法前往诊所时，高血压患者持续服用降压药的重要性；（2）建立简单可靠的预测指标，以检测在大地震后需要在避难所或家中接受临床检查和治疗的患有高血压的撤离者。
东日本大地震后，在岩手县的避难所进行了医疗巡诊。40名撤离者参与了一项横断面研究。评估了持续服用降压药的效果，并使用多元逻辑回归分析确定了撤离者中高血压的预测指标。
28名撤离者患有高血压（70%），其中9人无症状（32%）。大多数停止服用降压药的撤离者（92%；11/12）血压非常高，而继续服用降压药的撤离者（80%；8/10）为轻度高血压。在整个队列（n = 40）中，停止服用降压药者的收缩压显著高于继续服用降压药者，在避难所被诊断患有高血压的撤离者（n = 28）中也是如此（P<0.001）。在多变量分析中，年龄≥55岁（调整后的比值比，1.10；95%可信区间，1.01 - 1.21）预测高血压的敏感性为0.96，特异性为0.80。
本研究结果表明，降压药的持续服用可在大地震后的头10天内预防避难所中的严重高血压。在灾难发生后的早期阶段，关注简单预测指标的现场医疗巡诊可能是在高血压灾难受害者死于致命疾病之前对其进行检测和治疗的有效手段。
