摘要

Hypertension (HT) affects an estimated one billion people worldwide, nearly three-quarters of whom live in low- or middle-income countries (LMICs). In both developed and developing countries, only a minority of individuals with HT are adequately treated. The reasons are many but, as with other chronic diseases, they include weaknesses in health systems. We conducted a systematic review of the influence of national or regional health systems on HT awareness, treatment, and control.Eligible studies were those that analyzed the impact of health systems arrangements at the regional or national level on HT awareness, treatment, control, or antihypertensive medication adherence. The following databases were searched on 13th May 2013: Medline, Embase, Global Health, LILACS, Africa-Wide Information, IMSEAR, IMEMR, and WPRIM. There were no date or language restrictions. Two authors independently assessed papers for inclusion, extracted data, and assessed risk of bias. A narrative synthesis of the findings was conducted. Meta-analysis was not conducted due to substantial methodological heterogeneity in included studies. 53 studies were included, 11 of which were carried out in LMICs. Most studies evaluated health system financing and only four evaluated the effect of either human, physical, social, or intellectual resources on HT outcomes. Reduced medication co-payments were associated with improved HT control and treatment adherence, mainly evaluated in US settings. On balance, health insurance coverage was associated with improved outcomes of HT care in US settings. Having a routine place of care or physician was associated with improved HT care.This review supports the minimization of medication co-payments in health insurance plans, and although studies were largely conducted in the US, the principle is likely to apply more generally. Studies that identify and analyze complexities and links between health systems arrangements and their effects on HT management are required, particularly in LMICs. Please see later in the article for the Editors' Summary.

译文

据估计，全世界有 10亿人患有高血压，其中近生活在中低收入国家。在发达国家和发展中国家，只有少数 HT 患者得到了充分的治疗。原因有很多，但是和其他慢性病一样，它们包括卫生系统的弱点。我们对国家或区域卫生系统对 HT 意识、治疗和控制的影响进行了系统综述。符合条件的研究是分析区域或国家层面的卫生系统安排对 HT 意识、治疗、控制或抗高血压药物依从性的影响。2013年5月13日搜索了以下数据库: Medline 、 Embase 、 Global Health 、 LILACS 、全非洲信息、 IMSEAR 、 IMEMR 和 WPRIM。没有日期或语言限制。两位作者独立评估论文的纳入、提取数据和评估偏倚风险。对调查结果进行了叙述性综合。由于纳入研究中存在大量的方法学异质性，没有进行荟萃分析。包括了 53 项研究，其中 11 项是在 LMICs 中进行的。大多数研究评估了卫生系统融资，只有 4 项评估了人力、体力、社会或智力资源对 HT 结果的影响。减少药物共同支付与改善 HT 控制和治疗依从性有关，主要在美国环境中进行评估。总的来说，健康保险覆盖范围与美国环境下 HT 护理的改善结果相关。拥有一个常规的护理场所或医生与改善 HT 护理相关。该综述支持医疗保险计划中药物共同支付的最小化，尽管研究主要在美国进行，但该原则可能更普遍地适用。需要进行研究，以确定和分析卫生系统安排之间的复杂性和联系及其对 HT 管理的影响，特别是在 LMICs。请参见文章后面的编辑总结。