The Silent Threshold: Undiagnosed Hypertension Among Urban Refugees in Post-Conflict Zones

Léa Fontaine¹, Sophie Turner², Andreas Georgiou³, Ioanna Kyriazis⁴

Abstract

Background:
Hypertension is a leading non-communicable disease globally. However, in refugee populations living in urban post-conflict areas, the silent burden of undiagnosed hypertension remains largely invisible to health systems.

Objective:
To assess the prevalence and predictors of undiagnosed hypertension among adult refugees residing in urban post-conflict settlements and examine the barriers to diagnosis and care.

Methods:
A cross-sectional survey was conducted in 2024 among 812 adult refugees (aged 18–65 years) living in three urban refugee camps in a post-conflict zone of northern Lebanon. Blood pressure measurements were taken using WHO-recommended digital devices. Individuals were considered hypertensive if SBP ≥140 mmHg or DBP ≥90 mmHg without prior diagnosis. Demographic, socioeconomic, and health access data were collected through structured interviews. Logistic regression was used to identify predictors of undiagnosed hypertension.

Results:
Undiagnosed hypertension was found in 27.6% of participants. Older age (>45 years), BMI ≥30, and previous trauma exposure were significant predictors (OR = 2.3, 95% CI: 1.6–3.5; OR = 1.8, 95% CI: 1.2–2.6; OR = 1.5, 95% CI: 1.0–2.2, respectively). Despite 84% of respondents reporting recent interaction with a healthcare provider, only 19% had ever had their blood pressure measured. Key barriers included lack of awareness (56%), cost (33%), and mistrust in the health system (28%).

Conclusion:
Undiagnosed hypertension among urban refugee populations represents a neglected health crisis. Despite access to some services, gaps in screening, trust, and health literacy allow this condition to silently progress. Integrating routine NCD screening into refugee primary care systems is essential to avert long-term complications.