Warwick Medical School, University of Warwick, Coventry, UK.
Department of Health Sciences, University of York, York, North Yorkshire, UK.
BMJ Glob Health. 2020 Nov;5(11). doi: 10.1136/bmjgh-2020-002440.
Globally, a record number of people are affected by humanitarian crises caused by conflict and natural disasters. Many such populations live in settings where epidemiological transition is underway. Following the United Nations high level meeting on non-communicable diseases, the global commitment to Universal Health Coverage and needs expressed by humanitarian agencies, there is increasing effort to develop guidelines for the management of hypertension in humanitarian settings. The objective was to investigate the prevalence and incidence of hypertension in populations directly affected by humanitarian crises; the cascade of care in these populations and patient knowledge of and attitude to hypertension.
A literature search was carried out in five databases. Grey literature was searched. The population of interest was adult, non-pregnant, civilians living in any country who were directly exposed to a crisis since 1999. Eligibility assessment, data extraction and quality appraisal were carried out in duplicate.
Sixty-one studies were included in the narrative synthesis. They reported on a range of crises including the wars in Syria and Iraq, the Great East Japan Earthquake, Hurricane Katrina and Palestinian refugees. There were few studies from Africa or Asia (excluding Japan). The studies predominantly assessed prevalence of hypertension. This varied with geography and age of the population. Access to care, patient understanding and patient views on hypertension were poorly examined. Most of the studies had a high risk of bias due to methods used in the diagnosis of hypertension and in the selection of study populations.
Hypertension is seen in a range of humanitarian settings and the burden can be considerable. Further studies are needed to accurately estimate prevalence of hypertension in crisis-affected populations throughout the world. An appreciation of patient knowledge and understanding of hypertension as well as the cascade of care would be invaluable in informing service provision.
在全球范围内，由于冲突和自然灾害导致的人道主义危机影响了创纪录数量的人。许多这样的人群生活在流行病学转型正在进行的环境中。在联合国非传染性疾病问题高级别会议、全球对全民健康覆盖的承诺以及人道主义机构表达的需求之后，越来越多的人努力制定在人道主义环境中管理高血压的指南。目的是调查直接受人道主义危机影响的人群中高血压的患病率和发病率；这些人群中的护理级联以及患者对高血压的了解和态度。
在五个数据库中进行了文献检索。还搜索了灰色文献。感兴趣的人群是成年、非孕妇、居住在任何国家的平民，他们自 1999 年以来直接受到危机的影响。进行了资格评估、数据提取和质量评估。
61 项研究被纳入叙述性综合分析。它们报告了一系列危机，包括叙利亚和伊拉克战争、日本东部大地震、卡特里娜飓风和巴勒斯坦难民。来自非洲或亚洲（日本除外）的研究很少。这些研究主要评估了高血压的患病率。这因地理位置和人口年龄的不同而有所不同。护理的可及性、患者的理解能力和患者对高血压的看法都没有得到很好的检查。由于高血压诊断方法和研究人群选择方法的使用，大多数研究存在较高的偏倚风险。
在一系列人道主义环境中都能看到高血压，其负担可能相当大。需要进一步的研究来准确估计世界各地受危机影响人群的高血压患病率。了解患者对高血压的知识和理解以及护理级联将为提供服务提供宝贵的信息。
