Self-reported hypertension in adults residing in Campinas, Brazil: prevalence, associated factors and control practices in a population-based study.
Chronic non-communicable diseases account for 72% of deaths in Brazil, with 30.4% related to cardiovascular diseases (1). The prevalence of hypertension in the Brazilian population is 22 to 44% for adults and increases with age, reaching as high as 68% of older adults (2,3). On a global scale, hypertension is estimated to be responsible for 13% of deaths worldwide (4).
According to the Brazilian National Health Survey conducted in 2013, 21.4% of the population aged 18 years or older reported having a medical diagnosis of hypertension, which corresponds to 31.3 million Brazilians (5). Data from the National Home Survey conducted in 2008 indicate that the prevalence of hypertension was 38% higher among individuals with a lower level of schooling and 6% higher among those with no private health insurance, after controlling for age, sex and place of residence (6).
The greater life expectancy, nutritional transition and contemporary lifestyle, which translate to unhealthy behaviors, have contributed to the increasing frequency of hypertension in the population (7,8).
Despite the scientific consensus on the magnitude and impact of hypertension, which is considered a serious public health problem, control rates of the disease remain low (9). Such rates range from 1 to 15% in Latin America and Africa. In contrast, the hypertension control rate among individuals at primary care units in Germany is 64% of the total number of individuals with this disease and 18.5% among elderly individuals. A longitudinal study conducted in Italy reports a rate around 52%. Canada has the best control rate in the world (66%), which is attributed to primary care follow up and a continued educational program for healthcare professionals (10-12).
It is therefore necessary to highlight the role of healthcare services and health professionals as promoters of effective prevention and health recovery practices. In a review study conducted by Toledo et al. (13), the authors found that educational practices directed at individuals with hypertension are insufficient and most (80.4%) adopt normative protocols rather than employing a more liberating approach. According to Rabetti & Freitas (14), such practices result in actions with little impact on the control of hypertension.
Considering the challenges regarding the prevention and control of hypertension, the following were the aims of the present study: estimate the prevalence of self-reported hypertension among adults residing in the city of Campinas, Brazil; identify associations with socio-demographic characteristics, health-related behaviors, ailments, health status and the body mass index; and analyze the use of healthcare services and disease control practices adopted by Brazilian adults with hypertension.
A population-based, cross-sectional study was conducted involving data from the Campinas Municipal Health Survey (ISACAMP 2008/09). This survey was conducted between February 2008 and April 2009 by the Cooperating Center for the Analysis of the Health Situation of the Collective Health Department of Campinas State University for the analysis of health status among adolescents (10 to 19 years), adults (20 to 59 years) and elderly individuals (60 years or older). The target population was community-dwelling residents of urban areas in the city of Campinas. For the present study, the adult population was analyzed.
Independent samples of 1000 individuals in each age domain were selected, taking into account the estimate of a proportion of 0.50, sampling error between 4 and 5 percentage points, a 95% confidence interval and a 2.0 design effect.
ISACAMP 2008/09 employed two-stage cluster sampling. In the first stage, 50 census sectors were systematically selected, with the probability proportional to the number of residences. Sectors defined by the Brazilian Institute of Geography and Statistics were used and the addresses of the selected sectors were updated considering the time elapsed since the census. The second stage involved the definition of the number of residences to be selected in order to reach the desired sample size based on the ratio of individuals/residences for each age group. Thus, 700 residences were selected for interviews with adults, taking into account possible losses and an 80% response rate. All residents between 20 and 59 years of age at the selected homes were interviewed.
Information was collected using a structured questionnaire with 14 themes. The questionnaire had been tested in a pilot study and was administrated by trained, supervised interviewers.
The dependent variable was self-reported hypertension, which was determined by the answer to the following question: Has any doctor or other health professional even told you that you have high blood pressure?
Three sets of independent variables were selected for the analysis of factors associated with hypertension. A fourth set of variables on the use of healthcare services and disease control practices was analyzed in a descriptive fashion according to the possession or non-possession of a private health insurance plan.
? Socio-demographic variables: sex, age, ethnicity/self-reported skin color, conjugal situation, number of children, schooling (in years of study), monthly household income, possession of a health insurance plan and number of appliances in the home (freezer, vacuum cleaner, washing machine, air conditioner, dishwasher, computer, etc.).
? Health-related behaviors and nutritional status: smoking; alcohol intake frequency; alcohol dependence evaluated using the Alcohol Use Disorder Identification Test (AUDIT) with a cutoff point of [greater than or equal to] 8 on a scale of 0 to 40 points (15); physical activity during leisure, categorized as active (at least 150 minutes per week distributed among at least three days), insufficiently active (less than 150 minutes per week or 150+ minutes per week but distributed among less than three days per week) and inactive (no type of physical activity on any day of the week); nutritional status, evaluated based on the body mass index (BMI) calculated using weight and height and classified as underweight (< 18.5 kg/[m.sup.2]), ideal range (18.5 to 24.9 kg/[m.sup.2]), overweight (25.0 to 29.9 kg/[m.sup.2]) and obesity ([greater than or equal to] 30 kg/[m.sup.2]) (16).
* Ailments and health status: Number of chronic diseases and number of health complaints among those included on two checklists and self-rated health status; 1) chronic disease checklist--arterial hypertension, diabetes mellitus, heart disease, cancer, rheumatism/arthritis/arthrosis, osteoporosis, asthma/bronchitis/ emphysema, tendinitis/repetitive strain injury/ work-related musculoskeletal disorders and circulation problems; 2) health complaint checklist --headache/migraine, back pain/problem, allergy, emotional problem, dizziness/vertigo, insomnia and urinary problem.
* Use of healthcare services and disease-control practices: time elapsed since the diagnosis, visits to a physician for follow up of hypertension, reasons for not regularly visiting the physician, last visit to a physician for follow up of hypertension, participation in hypertension groups, having received medical counseling related to hypertension and measures taken to control the disease.
Data analysis initially involved estimates of the prevalence of hypertension according to the independent variables. Associations were tested using the chi-squared test with a 5% significance level. Prevalence ratios (crude and adjusted for sex and age) were calculated with 95% confidence intervals. A multiple Poisson regression model was employed in three steps. First, demographic and socioeconomic variables with a p-value < 0.20 in the univariate analysis were incorporated and only those with a p-value < 0.05 after adjustments remained in the model. Second, health-related behaviors and BMI were incorporated using the same cutoff points (p < 0.20 in the univarite analysis and p < 0.05 following adjustments for other variables). In the third, step, ailment and health status variables were incorporated with the same cutoff points as in the previous steps. Proportions were estimated using the chi-square test with a 5% significance level for the analysis of associations between possession/non-possession of a private insurance plan and both the use of health services and disease-control practices.
The data from the interview were entered in a blinded fashion in the Epidata program, version 3.1 (Epidata Assoc., Odense, Denmark). Statistical analysis were performed with the aid of the svy module of the Stata 11.0 program (Stata Corp., College Station, USA), which enables the consideration of weights and sampling design.
The ISACAMP 2008/09 program received approval from the human research ethics committee of the School of Medical Sciences of Campinas State University (Brazil).
Data from 957 adults were analyzed. The female sex accounted for 51.3% of the sample. Mean age was 37.5 years (men: 37.0 years; women: 37.9 years).
The prevalence of self-reported hypertension was 14.1% (95% CI: 12.3 to 16.1%) and was significantly higher among women, those who self-declared their ethnicity/skin color to be black, those with one or more children and those with a lower level of schooling. An increase in the frequency of hypertension occurred with the advance in age, as the prevalence was nearly tenfold higher among individuals aged 50 to 59 year in comparison to those aged 20 to 29 years. With regard to conjugal status, hypertension was more prevalent among separated and widowed individuals and lower among single individuals (Table 1).
The prevalence of self-reported hypertension was higher among individuals who remained inactive during leisure activities and ex-smokers and was lower among those who ingested alcoholic beverages one to four times per month. The prevalence increased with the increase in excess weight. The diagnosis of hypertension was reported by 36.8% of obese individuals, representing a 5.08-fold higher prevalence in comparison to those in the ideal BMI range (Table 2).
With regard to comorbidities, self-reported hypertension was more prevalent among individuals with three or more health complaints as well as those who reported one or more chronic diseases. The prevalence of hypertension was significantly higher among individuals who rated their health as good or poor/very poor in comparison to those who rated their health as very good or excellent (Table 3).
Table 4 displays the results of the multiple Poisson regression model. The prevalence of hypertension was higher among women, those aged 40 years or older, those who declared their ethnicity/skin color as black, those who remained inactive during leisure activities, ex-smokers, those with overweight or obesity, those who reported two or more chronic disease and those who rated their health as being good or poor/very poor.
Table 5 lists aspects related to hypertension control practices according to the possession or non-possession of a private health insurance plan. A total of 40.2% of the adults with hypertension were diagnosed six or more years earlier, 75.3% reported visiting regularly visiting a physician or healthcare service the purposes of disease control and 71.2% reported receiving counseling on how to manage the disease. Among those who did not visit a physician, the main reason was that they did not consider it necessary (63.4%). The vast majority (96.5%) did not participate in hypertension groups and 16.2% sought a physician or healthcare service more than one year earlier. No significant differences were found between those with a private health insurance plan and those dependent on the Brazilian public healthcare system with regard to regularly visiting a physician, using routine disease-control medications or having received orientations regarding how to manage hypertension. However, having a private health insurance plan was associated with greater frequencies of physical activity and dieting to lose or maintain weight as well as a greater frequency of disease-control practices.
The use of self-reported information on the presence of hypertension can be considered a limitation of the present study, since the prevalence is underestimated in this manner by limiting the investigation only to individuals who had access to a medical diagnosis and omitting those who are unaware of having high blood pressure. Although certain locations offer adequate medical care, individuals less attentive to their health can remain without a diagnosis even when having the disease. Nonetheless, population-based validation studies reveal that self-reported information on hypertension can be considered an appropriate indicator for estimating the prevalence of the disease (17,18).
Moreover, the present findings reveal segments of the adult population with greater prevalence rates of self-reported hypertension, which enables better guidance with regard to the planning of interventions. The findings add to existing data from previous studies, reaffirming the greater frequency of the disease among socially more vulnerable segments of society beyond the increase stemming from the ageing process.
The prevalence of hypertension was 14.1% in adults aged 20 to 59 years residing in the city of Campinas, which is virtually that same as the 14.0% prevalence reported for the Brazilian population in the 2008 National Household Survey, which revealed that the prevalence increases with age from 3.2% among individuals aged 20 to 29 years to 35% among those aged 50 to 59 years6. Data from the Vigitel national telephone survey in 2008 indicate a higher figure of around 23.1% in the adult population ([greater than or equal to] 18 years of age), with changes accompanying the increase in age and with the highest rates among young individuals (18 to 24 years) found in the cities of Teresina and Porto Alegre (10.6%) (19).
Hypertension was more prevalent among women, which is in agreement with data reported in previous studies (5,6,17). Information from the Vigitel telephone survey demonstrate a greater prevalence rate of the disease among women between 2006 and 201120. This gender difference may be explained by the greater perception of physical signs and symptoms of health conditions among women as well as greater concerns regarding health and seeking medical assistance (6,21,22).
The increase in prevalence with the advance in age is also in agreement with data described in the literature (5,6,20,23). This increase is related to the longer life expectancy of the population, which leads to a greater burden of chronic diseases, disability and the demand for health services (24).
The prevalence of hypertension was higher among adults with a lower level of schooling, as reported in other studies (5,20). Analyzing data from the 2008 National Household Survey, Barros et al. (6) found that the chronic diseases analyzed, except tendinitis and cancer, were more prevalent among individuals with less schooling. Lima-Costa (25) found that adults and elderly individuals with less schooling had greater frequencies of smoking and a sedentary lifestyle as well as ingested fruits, vegetables and legumes less. According to the World Health Organization (4) chronic diseases mainly affect socially more vulnerable segments of society due to greater exposure to risk factors, less access to healthcare services and a lower level of health-related information.
With regard to ethnicity, hypertension was more prevalent among individuals who declared themselves to be black, which is in agreement with data reported in previous studies and reaffirms historically and socially determined ethno-racial inequalities (26-29). According to Malta et al. (26), disparities between blacks and whites are also evidenced in rates of passive smoking in the work environment, the use of alcoholic beverages, the consumption of fatty meats, fruits and vegetables and the practice of physical activity in the workplace associated with the exercise of occupational activities that require lower qualifications.
Physical inactivity contributes to more than three million deaths annually and constitutes an important risk factor for non-communicable chronic diseases (4). The present findings lend support to this statement, as the prevalence of hypertension was higher among individuals who were inactive during leisure activities. Data from the Brazilian Health Ministry reveal that 16.2% (95% CI: 15.6 to 16.9%) of individuals ages 18 years or older do not practice physical activity (30). Exercising at least 30 minutes per day most days of the week is recommended for the prevention of hypertension and lowering blood pressure levels (31-32).
Self-reported diagnoses of hypertension were more prevalent among ex-smokers in comparison to individuals who had never smoked. It is estimated that smoking is responsible for 9% of deaths in the world (4). The greater prevalence of hypertension among ex-smokers in the present investigation is likely the result of reverse causality, as the emergence of hypertension may have led individuals to give up smoking. However, further studies are needed to confirm this hypothesis.
With regard to nutritional status, hypertension was more prevalent among individuals with overweight or obesity, which is similar to findings described by other researchers (28,33,34). In Brazil, the prevalence of excess weight increased from 43.2 to 51.0% between 2006 and 2012, which is an annual increase of 1.37%, and the prevalence of obesity increased from 11.6 to 17.4% (annual increase of 0.89%) (35). In a cross-sectional study involving a sample of 1584 individuals aged 18 to 64 years, Sarno and Monteiro (36) found a risk of hypertension attributable to a body mass index [greater than or equal to] 25 kg/[m.sup.2] among 56% of men and 41% of women, confirming the increased risk of hypertension with the occurrence of excess weight.
The prevalence of hypertension was higher among individuals who reported having two or more chronic diseases. The findings of clinical studies demonstrate that 70% of individuals with diabetes also have hypertension and the coexistence of the two conditions significantly increases the risk of developing other comorbidities (37). Moreover, hypertension was more prevalent among individuals who rated their health as not being very good or excellent. In a population-based study conducted in the city of Pelotas (southern Brazil), 45.4% of adults with hypertension perceived their health as being fair or poor (38).
The main finding of the present study regards hypertension control strategies. Adults with a private health insurance plan performed physical activity more and dieted more to lose or maintain weight, although physical activity was reported by only 17.4% and a controlled diet was reported by only 16.1% of the individuals with hypertension. Souza et al. (39) report similar findings in a study conducted in Novo Hamburgo (southern Brazil), in which these figures were also low, as 22.1% and 7.4% of individuals with hypertension registered with the Hiperdia Program recognized physical exercise and the maintenance of adequate weight, respectively, as important practices for controlling the disease. The findings are also in agreement with data reported by Zaitune et al. (23) in a study conducted in Campinas, which revealed greater recognition on the part of elderly individuals regarding the use of dieting and physical activities as strategies for controlling hypertension, despite the low rates of carrying out such practices (9.0 and 22.4%, respectively).
The present results underscore the importance of the qualification of services directed at education activities for health promotion, especially in primary care. Indeed, an experience in Canada reveals that primary care follow up combined with the continued education of healthcare professionals leads to better results regarding the control of hypertension (12).
The findings lend support to the relevance of the investments that have been made in Brazil and the rest of the world to address non-communicable chronic diseases, such as hypertension, beyond medicinal treatment, as there is consensus in the scientific community regarding the positive effects of changing one's lifestyle (40,41). However, it is necessary to overcome the normative approach that remains dominant in health services, as Toledo et al. (13) point out in reference to educational approaches for individuals with hypertension, since the qualification of healthcare services exerts a positive impact on the efficiency of disease control practices (14).
The possession or non-possession of a private health insurance plan among adults with hypertension was not significantly associated with the use of healthcare services or having received medical orientation regarding the management of the disease, which demonstrates equity in access to health care among such patients in the city of Campinas (southeastern Brazil). However, despite access to regular medical follow up and counseling with regard to managing the hypertension, an insufficient proportion of adults adopt changes in lifestyle to control the disease, such as the practice of physical exercise and adequate eating habits to lose or maintain weight.
This is a worrisome situation that underscores the central role of state and municipal public health administrators, who need to work in an intersectoral manner to strengthen the integrality of care through strategies outlined in the Brazilian National Plans for the Control of Chronic Diseases, in such a way that the actions can lead to the achievement of goals established by the Health Ministry.
LTO Zangirolani and D Assumpcao participated in the design, analysis and writing of the article; MAT Medeiros of the final review of the article; MBA Barros of research coordination, analysis and final article review.
(1.) Malta DC, Moura L, Prado RR, Escalante JC, Schmidt MI, Duncan BB. Mortalidade por doencas cronicas nao transmissiveis no Brasil e suas regioes, 2000 a 2011. Epidemiol Serv Saude 2014; 23(4):599-608.
(2.) Sociedade Brasileira de Cardiologia (SBC). VI Diretrizes Brasileiras de Hipertensao. Arq Bras Cardiol 2010; 95(Supl.1):1-51.
(3.) Picon RV, Fuchs FD, Moreira LB, Fuchs SC. Prevalence of hypertension among elderly persons in urban Brazil: a systematic review with meta-analysis. Am J Hypertens 2013; 26(4):541-548.
(4.) World Health Organization (WHO). Global status report on noncommunicable diseases 2010. Geneva: WHO; 2011.
(5.) Instituto Brasileiro de Geografia e Estatistica (IBGE). Pesquisa Nacional de Saude 2013: Percepcao do estado de saude, estilos de vida e doencas cronicas. Rio de Janeiro: IBGE; 2014.
(6.) Barros MBA, Francisco PMSB, Zanchetta LM, Cesar CLG. Tendencias das desigualdades sociais e demograficas na prevalencia de doencas cronicas no Brasil, PNAD: 2003-2008. Cien Saude Colet 2011; 16(9):37553768.
(7.) Brasil. Ministerio da Saude (MS). Plano de Acoes Estrategicas para o Enfrentamento das Doencas Cronicas Nao Transmissiveis (DCNT) no Brasil 2011-2022. Brasilia: MS; 2011.
(8.) Veras R. Envelhecimento populacional contemporaneo: demandas, desafios e inovacoes. Rev Saude Publica 2009; 43(3):548-554.
(9.) Brasil. Ministerio da Saude (MS). Estrategias para o cuidado da pessoa com doenca cronica: hipertensao arterial sistemica. Brasilia: MS; 2013.
(10.) Sharma AM, Wittchen HU, Kirch W, Pittrow D, Ritz E, Goke B, Lehnert H, Tschope D, Krause P, Hofler M, Pfister H, Bramlage P, Unger T; HYDRA Study Group. High prevalence and poor control of hypertension in primary care: cross-sectional study. J Hypertens 2004; 22(3):479-486.
(11.) Grandi AM, Maresca AM, Sessa A, Stella R, Ponti D, Barlocco E, Banfi F, Venco A. Longitudinal study on hypertension control in primary care: the Insubria study. Am J Hypertens 2006; 19(2):140-145.
(12.) Campbell NR, McAlister FA, Brant R, Levine M, Drouin D, Feldman R, Herman R, Zarnke K; Canadian Hypertension Education Process and Evaluation Committee. Temporal trends in antihypertensive drug prescriptions in Canada before and after introduction of the Canadian Hypertension Education Program. J Hypertens 2003; 21(8):1591-1597.
(13.) Toledo MM, Rodrigues SC, Chiesa AM. Educacao em saude no enfrentamento da hipertensao arterial: uma nova otica para um velho problema. Texto Contexto Enferm 2007; 16(2):233-238.
(14.) Rabetti AP, Freitas SFT. Avaliacao das acoes em hipertensao arterial sistemica na atencao basica. Rev Saude Publica 2011; 45(2):258-268.
(15.) Lima CT, Freire ACC, Silva APB, Teixeira RM, Farrel M, Prince M. Concurrent and construct validity of the AUDIT in an urban Brazilian sample. Alcohol and Alcoholism 2005; 40(6):584-589.
(16.) World Health Organization (WHO). Physical status: the use and interpretation of anthropometry. Geneva: WHO; 1995.
(17.) Lima-Costa MF, Peixoto SV, Firmo JOA. Validade da hipertensao arterial auto-referida e seus determinantes (projeto Bambui). Rev Saude Publica 2004; 38(5):637642.
(18.) Chrestani MAD, Santos IS, Matijasevich AM. Hipertensao arterial sistemica auto-referida: validacao diagnostica em estudo de base populacional. Cad Saude Publica 2009; 25(11):2395-2406.
(19.) Muraro AP, Santos DF, Rodrigues PRM, Braga JU. Fatores associados a Hipertensao Arterial Sistemica autorreferida segundo VIGITEL nas 26 capitais brasileiras e no Distrito Federal em 2008. Cien Saude Colet 2013; 18(5):1387-1398.
(20.) Andrade SSCA, Malta DC, Iser BM, Sampaio PC, Moura L. Prevalencia da hipertensao arterial autorreferida nas capitais brasileiras em 2011 e analise de sua tendencia no periodo de 2006 a 2011. Rev Bras Epidemiol 2014; 17(Supl. 1):215-226.
(21.) Pinheiro RS, Viacava F, Travassos C, Brito AS. Genero, morbidade, acesso e utilizacao de servicos de saude no Brasil. Cien Saude Colet 2002; 7(4):687-707.
(22.) Instituto Brasileiro de Geografia e Estatistica (IBGE). Pesquisa Nacional por Amostra de Domicilios. Um Panorama da Saude no Brasil: acesso e utilizacao dos servicos, condicoes de saude e fatores de risco e protecao a saude 2008. Rio de Janeiro: IBGE; 2010.
(23.) Zaitune MPA, Barros MBA, Cesar CLG, Carandina L, Goldbaum M. Hipertensao arterial em idosos: prevalencia, fatores associados e praticas de controle no Municipio de Campinas, Sao Paulo, Brasil. Cad Saude Publica 2006; 22(2):285-294.
(24.) Barros MBA, Cesar CLG, Carandina L, Torre GD. Desigualdades sociais na prevalencia de doencas cronicas no Brasil, PNAD-2003. Cien Saude Colet 2006; 11(4):911-926.
(25.) Lima-Costa MF. A escolaridade afeta, igualmente, comportamentos prejudiciais a saude de idosos e adultos mais jovens?--Inquerito de Saude da Regiao Metropolitana de Belo Horizonte, Minas Gerais, Brasil. Epidemiol Serv Saude 2004; 13(4):201-208.
(26.) Malta DC, Moura L, Bernal RTI. Diferenciais dos fatores de risco de Doencas Cronicas nao Transmissiveis na perspectiva de raca/cor. Cien Saude Colet 2015; 20(3):713-725.
(27.) Weber MA, Schiffrin EL, White WB, Mann S, Lindholm LH, Kenerson JG, Flack JM, Carter BL, Materson BJ, Ram CV, Cohen DL, Cadet JC, Jean-Charles RR, Taler S, Kountz D, Townsend RR, Chalmers J, Ramirez AJ, Bakris GL, Wang J, Schutte AE, Bisognano JD, Touyz RM, Sica D, Harrap SB. Clinical practice guidelines for the management of hypertension in the community. A statement by the American Society of Hypertension and the International Society of Hypertension. J Hypertens 2014; 16(1):14-26.
(28.) Costa JSD, Barcellos FC, Sclowitz ML, Sclowitz IKT, Castanheira M, Olinto MTA, Menezes AMB, Gigante DP, Macedo S, Fuchs SC. Prevalencia de hipertensao arterial em adultos e fatores associados: um estudo de base populacional urbana em Pelotas, Rio Grande do Sul, Brasil. Arq Bras Cardiol 2007; 88(1):59-65.
(29.) Laguardia J. Raca, genetica & hipertensao: nova genetica ou velha eugenia? Historia, Ciencias, Saude--Manguinhos 2005; 12(2):371-393.
(30.) Brasil. Ministerio da Saude (MS). VIGITEL Brasil 2013: vigilancia de fatores de risco e protecao para doencas cronicas por inquerito telefonico. Brasilia: MS; 2014.
(31.) Dasgupta K, Quinn RR, Zarnke KB, Rabi DM, Ravani P, Daskalopoulou SS, Rabkin SW, Trudeau L, Feldman RD, Cloutier L, Prebtani A, Herman RJ, Bacon SL, Gilbert RE, Ruzicka M, McKay DW, Campbell TS, Grover S, Honos G, Schiffrin EL, Bolli P, Wilson TW, Lindsay P, Hill MD, Coutts SB, Gubitz G, Gelfer M, Vallee M, Prasad GV, Lebel M, McLean D, Arnold JM, Moe GW, Howlett JG, Boulanger JM, Larochelle P, Leiter LA, Jones C, Ogilvie RI, Woo V, Kaczorowski J, Burns KD, Petrella RJ, Hiremath S, Milot A, Stone JA, Drouin D, Lavoie KL, Lamarre-Cliche M, Tremblay G, Hamet P, Fodor G, Carruthers SG, Pylypchuk GB, Burgess E, Lewanczuk R, Dresser GK, Penner SB, Hegele RA, McFarlane PA, Khara M, Pipe A, Oh P, Selby P, Sharma M, Reid DJ, Tobe SW, Padwal RS, Poirier L; Canadian Hypertension Education Program. The 2014 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. Can J Cardiol 2014; 30(5):485-501.
(32.) Brook RD, Appel LJ, Rubenfire M, Ogedegbe G, Bisognano JD, Elliott WJ, Fuchs FD, Hughes JW, Lackland DT, Staffileno BA, Townsend RR, Rajagopalan S; American Heart Association Professional Education Committee of the Council for High Blood Pressure Research, Council on Cardiovascular and Stroke Nursing, Council on Epidemiology and Prevention, and Council on Nutrition, Physical Activity. Beyond medications and diet: alternative approaches to lowering blood pressure. A Scientific Statement from the American Heart Association. Hypertension 2013; 61(6):1360-1383.
(33.) Barbosa LS, Scala LCN, Ferreira MG. Associacao entre marcadores antropometricos de adiposidade corporal e hipertensao arterial na populacao adulta de Cuiaba, Mato Grosso. Rev Bras Epidemiol 2009; 12(2):237-247.
(34.) Papathanasiou G, Zerva E, Zacharis I, Papandreou M, Papageorgiou E, Tzima C, Georgakopoulos D, Evangelou A. Association of high blood pressure with body mass index, smoking and physical activity in healthy young adults. Open Cardiovasc Med J 2015; 9:5-17.
(35.) Malta DC, Andrade SC, Claro RM, Bernal RTI, Monteiro CA. Evolucao anual da prevalencia de excesso de peso e obesidade em adultos nas capitais dos 26 estados brasileiros e no Distrito Federal entre 2006 e 2012. Rev Bras Epidemiol 2014; 17(Supl.1):267-276.
(36.) Sarno F, Monteiro CA. Importancia relativa do Indice de Massa Corporal e da circunferencia abdominal na predicao da hipertensao arterial. Rev Saude Publica 2007; 41(5):788-796.
(37.) Alessi A, Bonfim AV, Brandao AA, Feitosa A, Amodeo C, Alves CR, Brasil DP, Souza DSM, Barbosa E, Consolim-Colombo FM, Borelli F, Fonseca FH, Lopes HF, Chaves H, Bortolotto LA, Martin LC, Scala LCN, Mota-Gomes MA, Malachias MVB, Izar MC, Fonseca MIH, Neves MFT, Morais NS, Passarelli Junior O, Jardim PCV, Toscano PR, Miranda RD, Franco R, Betti RTB, Pedrosa RP, Povoa R, Carneiro SB, Jardim T, Barroso WKS. I Posicionamento Brasileiro em hipertensao arterial e diabetes mellitus. Arq Bras Cardiol 2013; 100(6):491-501.
(38.) Reichert FF, Loch MR, Capilheira MF. Autopercepcao de saude em adolescentes, adultos e idosos. Cien Saude Colet 2012; 17(12):3353-3362.
(39.) Souza CS, Stein AT, Bastos GAN, Pellanda LC. Controle da pressao arterial em hipertensos do Programa Hiperdia: estudo de base territorial. Arq Bras Cardiol 2014; 102(6):571-578.
(40.) Organizacao Pan-Americana de Saude (OPAS). Estrategia e plano de acao regional para um enfoque integrado a prevencao e controle das doencas cronicas, inclusive regime alimentar, atividade fisica e saude. Washington: OPAS; 2007.
(41.) Malta DC, Silva Junior JB. O Plano de Acoes Estrategicas para o Enfrentamento das Doencas Cronicas Nao Transmissiveis no Brasil e a definicao das metas globais para o enfrentamento dessas doencas ate 2025: uma revisao. Epidemiol Serv Saude 2013; 22(1):151-164.
Article submitted 28/01/2016
Final version submitted 27/06/2016
Lia Thieme Oikawa Zangirolani 
Daniela de Assumpcao 
Maria Angelica Tavares de Medeiros 
Marilisa Berti Azevedo Barros 
 Instituto Saude e Sociedade, Politicas Publicas e Saude Coletiva, Universidade Federal de Sao Paulo Campus Baixada Santista. R. Silva Jardim 136/sl.218, Vila Mathias. 11015-020 Santos SP Brasil. firstname.lastname@example.org
 Departamento de Saude Coletiva, Faculdade de Ciencias Medicas, Unicamp. Campinas SP Brasil.
Table 1. Prevalence and prevalence ratios (PR) of self/reported hypertension in adults aged 20 to 59 years according to demographic and socioeconomic variables. Campinas Health Survey (ISACAMP, 2008/ 09). Variables and categories n % (95% CI) Sex p = 0.0138 * Male 449 11.5 (9.3-14.2) Female 508 16.5 (13.8-19.7) Total 957 14.1 (12.3-16.1) Age group (in years) p = 0.0000 * 20 to 29 305 3.3 (1.6-6.5) 30 to 39 232 7.4 (4.4-12.0) 40 to 49 224 21.1 (16.6-26.5) 50 to 59 196 31.9 (26.2-38.1) Ethnicity/skin color p = 0.0421 * White 697 12.8 (10.8-15.0) Black 85 21.4 (13.9-31.5) Brown 168 15.9 (11.8-21.1) Conjugal status p = 0.0000 * Married/stable union 594 15.5 (13.1-18.2) Separated/widowed 105 27.9 (21.8-35.0) Single 258 5.5 (3.2-9.4) Number of children p = 0.0000 * 0 297 4.8 (2.9-8.0) 1 to 2 450 14.1 (11.7-16.9) 3 or more 210 28.1 (22.9-33.9) Schooling (in years) p = 0.0000 * 0 to 7 273 24.5 (19.4-30.5) 8 to 11 400 10.7 (8.0-14.1) 12 or more 284 9.4 (6.6-13.3) Household income p = 0.3782 * < 1 Brazilian monthly minimum wage (BMMW) 382 15.0 (12.1-18.4) [greater than or equal to] 1 to [less than or equal to] 3 times BMMW 395 12.4 (9.4-16.2) > 3 times BMMW 180 15.9 (11.9-21.0) Private health insurance plan p = 0.7659 * Yes 412 13.8 (11.2-16.8) No 545 14.4 (11.9-17.2) Number of appliances in home p = 0.2984 * 1 to 5 110 18.7 (13.4-25.4) 6 to 10 287 13.7 (10.0-18.3) 11 or more 558 13.5 (11.2-16.2) Variables and categories PR (95% CI) Sex Male 1 Female 1.43 (1.08-1.90) Total Age group (in years) 20 to 29 1 30 to 39 2.25 (1.01-4.98) 40 to 49 6.45 (3.03-13.75) 50 to 59 9.74 (4.71-20.13) Ethnicity/skin color White 1 Black 1.68 (1.08-2.60) Brown 1.25 (0.90-1.73) Conjugal status Married/stable union 1 Separated/widowed 1.80 (1.30-2.50) Single 0.36 (0.20-0.63) Number of children 0 1 1 to 2 2.91 (1.71-4.95) 3 or more 5.80 (3.38-9.93) Schooling (in years) 0 to 7 2.59 (1.68-4.01) 8 to 11 1.13 (0.70-1.82) 12 or more 1 Household income < 1 Brazilian monthly minimum wage (BMMW) 1 [greater than or equal to] 1 to [less than or equal to] 3 times BMMW 0.83 (0.58-1.18) > 3 times BMMW 1.06 (0.75-1.51) Private health insurance plan Yes 1 No 1.04 (0.79-1.37) Number of appliances in home 1 to 5 1.38 (0.94-2.04) 6 to 10 1.01 (0.70-1.45) 11 or more 1 n: number of individuals in sample not weighted. * p-value of chi-squared test. Table 2. Prevalence and prevalence ratios (PR) of self-reported hypertension in adults aged 20 to 59 years according to health-related behaviors and body mass index (BMI). Campinas Health Survey (ISACAMP, 2008/09). Variables and categories n % (95% CI) Leisure p = 0.0007 * Inactive 644 17.2 (14.8-19.8) Insufficiently active 134 7.1 (4.0-12.3) Active 179 8.7 (5.1-14.2) Tobacco p = 0.0032 * Non-smoker 648 12.7 (10.4-15.5) Ex-smoker 110 26.4 (19.0-35.4) Smoker 197 11.9 (7.6-18.2) Frequency of alcohol intake p = 0.0089 * Never 501 16.7 (13.5-20.3) 1 to 4 times per month 329 8.8 (6.0-12.7) 2 or more times per week 125 18.4 (12.3-26.6) Alcohol dependency p = 0.4465 * Negative 868 13.8 (11.8-16.1) Positive 88 16.7 (10.6-25.2) BMI (kg/[m.sup.2]) p = 0.0000 * Underweight 37 7.6 (2.6-19.8) Ideal range 455 7.2 (5.4-9.6) Overweight 301 15.2 (12.1-18.9) Obesity 144 36.8 (30.8-43.2) Variables and categories PR (95% CI) Leisure Inactive 1.98 (1.17-3.33) Insufficiently active 0.82 (0.37-1.80) Active 1 Tobacco Non-smoker 1 Ex-smoker 2.07 (1.41-3.03) Smoker 0.93 (0.55-1.58) Frequency of alcohol intake Never 1 1 to 4 times per month 0.53 (0.33-0.83) 2 or more times per week 1.10 (0.68-1.77) Alcohol dependency Negative 1 Positive 1.21 (0.74-1.96) BMI (kg/[m.sup.2]) Underweight 1.05 (0.36-3.01) Ideal range 1 Overweight 2.10 (1.43-3.09) Obesity 5.08 (3.61-7.16) n: number of individuals in sample not weighted. * p-value of chi-squared test. Table 3. Prevalence and prevalence ratios (PR) of self/reported hypertension in adults aged 20 to 59 years according to ailments and health status. Campinas Health Survey (ISACAMP, 2008/09). Variables and categories n % (95% CI) PR (95% CI) Number of health complaints p = 0.0000 * 0 287 8.5 (5.7-12.4) 1 1 to 2 456 13.2 (10.8-16.1) 1.55 (0.99-2.44) 3 or more 214 23.9 (18.9-29.7) 2.81 (1.80-4.38) Number of chronic diseases p = 0.0000 * 0 654 8.8 (7.1-10.9) 1 1 208 18.1 (13.1-24.5) 2.05 (1.36-3.11) 2 or more 85 42.1 (31.5-53.5) 4.78 (3.35-6.83) Self-rated health p = 0.0000 * Excellent/very good 399 5.9 (4.2-8.2) 1 Good 493 18.5 (15.7-21.8) 3.15 (2.14-4.64) Poor/very poor 65 33.0 (20.6-48.2) 5.60 (3.17-9.88) n: number of individuals in sample not weighted. * p-value of chi-squared test. Table 4. Results of Poisson multivariate regression model for variables associated with self/reported hypertension. Campinas Health Survey (ISACAMP, 2008/09). First step Second step [PR.sub.adjusted] * [PR.sub.adjusted] ** Variables and categories (95% CI) (95% CI) Sex Male 1 1 Female 1.37 (1.03-1.82) 1.31 (0.99-1.72) Age group (in years) 20 to 29 1 1 30 to 39 2.08 (0.93-4.63) 1.61 (0.74-3.50) 40 to 49 6.03 (2.76-13.13) 4.55 (2.16-9.62) 50 to 59 8.65 (4.04-18.53) 5.90 (2.73-12.70) Ethnicity/skin color White 1 1 Black 1.87 (1.27-2.74) 1.58 (1.15-2.19) Brown 1.29 (0.93-1.79) 1.21 (0.87-1.68) Schooling (in years) 0 to 7 1.65 (1.05-2.60) 1.49 (0.98-2.26) 8 to 11 1.23 (0.75-2.00) 1.19 (0.75-1.88) 12 or more 1 1 Leisure Inactive 1.75 (1.09-2.81) Insufficiently active 1.05 (0.55-2.00) Active 1 Tobacco Non-smoker 1 Ex-smoker 1.40 (1.03-1.89) Smoker 0.91 (0.57-1.45) Body mass index (Kg/[m.sup.2]) Underweight 0.89 (0.35-2.28) Ideal range 1 Overweight 1.50 (1.07-2.10) Obesity 3.04 (2.19-4.23) Number of chronic diseases 0 1 2 or more Self-rated health Excellent/very good Boa Poor/very poor Third step [PR.sub.adjusted] *** Variables and categories (95% CI) Sex Male 1 Female 1.14 (0.85-1.53) Age group (in years) 20 to 29 1 30 to 39 1.56 (0.72-3.34) 40 to 49 4.05 (1.87-8.76) 50 to 59 4.65 (2.12-10.18) Ethnicity/skin color White 1 Black 1.48 (1.00-2.18) Brown 1.16 (0.84-1.61) Schooling (in years) 0 to 7 1.18 (0.80-1.74) 8 to 11 0.97 (0.63-1.51) 12 or more 1 Leisure Inactive 1.56 (0.98-2.48) Insufficiently active 0.97 (0.51-1.87) Active 1 Tobacco Non-smoker 1 Ex-smoker 1.18 (0.85-1.64) Smoker 0.84 (0.53-1.33) Body mass index (Kg/[m.sup.2]) Underweight 0.87 (0.34-2.24) Ideal range 1 Overweight 1.39 (0.96-2.02) Obesity 2.56 (1.80-3.63) Number of chronic diseases 1 0 1 1 1.31 (0.90-1.91) 2 or more 1.31 (0.90-1.91) Self-rated health 1.71 (1.18-2.47) Excellent/very good 1 Boa 1.95 (1.26-3.01) Poor/very poor 1.93 (1.06-3.50) * Prevalence ratio adjusted for demographic and socioeconomic variables. ** Adjusted for demographic variables, socioeconomic variables, health-related behaviors and body mass index. *** Adjusted for all variables in table. Table 5. Use of healthcare services, knowledge on hypertension and disease control practices among adults aged 20 to 59 years according to possession of private health insurance plan. Campinas Health Survey (ISACAMP, 2008/09). Total Variables and categories n % Time elapsed since diagnosis of hypertension (in years) 0 to 5 83 59.8 6 or more 56 40.2 Total 139 Visit to physician/health service for hypertension follow up No 34 24.7 Yes 105 75.3 Reason for not regularly visiting physician/health service Does not think it necessary 21 63.4 Lack of time 4 11.2 Difficulty regarding geographic access 2 5.5 Others 7 20.0 Total 34 Last visit to physician/health service for hypertension follow up In previous month 27 19.5 One year ago 89 64.3 More than one year ago 22 16.2 Participation in hypertension groups No 134 96.5 Yes 5 3.5 Received counseling from physician/health service regarding hypertension No 39 28.8 Yes 99 71.2 Hypertension control measures Diet without salt 31 22.2 Dieting to lose/maintain weight 12 9.0 Physical activity 14 10.2 Routine medication 103 73.9 Medication when problem arises 14 10.0 Nothing 16 11.6 Private health insurance Yes No Variables and categories n % n % Time elapsed since diagnosis of hypertension (in years) 0 to 5 33 57.0 50 61.9 6 or more 25 43.0 31 38.1 Total 58 81 Visit to physician/health service for hypertension follow up No 11 19.2 23 28.7 Yes 47 80.8 58 71.3 Reason for not regularly visiting physician/health service Does not think it necessary 8 73.2 13 58.4 Lack of time 1 8.6 3 12.5 Difficulty regarding geographic access 0 0.0 2 8.3 Others 3 26.8 4 16.6 Total 11 23 Last visit to physician/health service for hypertension follow up In previous month 10 17.7 17 20.9 One year ago 38 65.0 51 63.7 More than one year ago 10 17.3 12 15.3 Participation in hypertension groups No 57 98.2 77 95.3 Yes 1 1.7 4 4.7 Received counseling from physician/health service regarding hypertension No 15 26.6 24 30.5 Yes 42 73.4 57 69.5 Hypertension control measures Diet without salt 13 23.1 18 21.6 Dieting to lose/maintain weight 9 16.1 3 3.6 Physical activity 10 17.4 4 4.8 Routine medication 42 72.6 61 74.9 Medication when problem arises 7 11.9 7 8.6 Nothing 4 6.8 12 15.3 Variables and categories p value * Time elapsed since diagnosis of 0.4863 hypertension (in years) 0 to 5 6 or more Total Visit to physician/health service for 0.2620 hypertension follow up No Yes Reason for not regularly visiting 0.3040 physician/health service Does not think it necessary Lack of time Difficulty regarding geographic access Others Total Last visit to physician/health service for 0.8848 hypertension follow up In previous month One year ago More than one year ago Participation in hypertension groups 0.3739 No Yes Received counseling from physician/health 0.6275 service regarding hypertension No Yes Hypertension control measures Diet without salt 0.8209 Dieting to lose/maintain weight 0.0063 Physical activity 0.0115 Routine medication 0.7308 Medication when problem arises 0.5110 Nothing 0.1161 n: number of individuals in sample not weighted. * p-value of chi-squared test.
|Printer friendly Cite/link Email Feedback|
|Author:||Zangirolani, Lia Thieme Oikawa; de Assumpcao, Daniela; de Medeiros, Maria Angelica Tavares; Barros,|
|Publication:||Ciencia & Saude Coletiva|
|Date:||Apr 1, 2018|
|Previous Article:||The medical archive work process: new perspectives concerning health care.|
|Next Article:||Integrality in Brazil and Venezuela: similarities and complementarities.|