Hypertension/epidemiology

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Editorial

The Journey Towards Hypertension Control in Brazil

Arterial hypertension (AH) is a highly prevalent cardiovascular, cerebrovascular, and renal risk factor worldwide. This associated risk can be reduced through the institution of a well-established and scientifically validated therapy. For these reasons, AH control plays a role in preventing chronic degenerative diseases in public health. The controlled AH rate reflects the quality of health care offered to the population.

The Arterial Hypertension control rate evaluated by the office and residential measurements: LHAR National Registry, recently published in the Arquivos Brasileiros de Cardiologia, shows an overview of this scenario in Brazil. Some findings of this study deserve to be highlighted.

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Original Article

Monocyte Low-Density Lipoprotein Receptor-Related Protein 1 (LRP1) Expression Correlates with cIMT in Mexican Hypertensive Patients

Ricardo Gamboa et al. María José Jaramillo-Estrella María del Rocio Martínez-Alvarado Maria Elena Soto … Yazmin Estela Torres-Paz David de Gonzalo-Calvo Leonardo Del Valle-Mondragón Rebeca López-Marure Vicenta C. Llorente-Cortés Claudia Huesca-Gómez

Abstract

Background

Arterial hypertension (HTA) represents a major risk factor for cardiovascular morbidity and mortality. It is not yet known which specific molecular mechanisms are associated with the development of essential hypertension.

Objective

In this study, we analyzed the association between LRP1 monocyte mRNA expression, LRP1 protein expression, and carotid intima media thickness (cIMT) of patients with essential hypertension.

Methods

The LRP1 monocyte mRNA expression and protein levels and cIMT were quantified in 200 Mexican subjects, 91 normotensive (NT) and 109 hypertensive (HT). Statistical significance was defined as p < 0.05.

Results

HT patients group had highly significant greater cIMT as compared to NT patients (p=0.002) and this correlated with an increase in the expression of LRP1 mRNA expression (6.54 vs. 2.87) (p = 0.002) and LRP1 protein expression (17.83 vs. 6.25), respectively (p = 0.001). These differences were maintained even when we divided our study groups, taking into account only those who presented dyslipidemia in both, mRNA (p = 0.041) and proteins expression (p < 0.001). It was also found that Ang II mediated LRP1 induction on monocytes in a dose and time dependent manner with significant difference in NT vs. HT (0.195 ± 0.09 vs. 0.226 ± 0.12, p = 0.046).

Conclusion

An increase in cIMT was found in subjects with hypertension, associated with higher mRNA and LRP1 protein expressions in monocytes, irrespective of the presence of dyslipidemias in HT patients. These results suggest that LRP1 upregulation in monocytes from Mexican hypertensive patients could be involved in the increased cIMT. (Arq Bras Cardiol. 2021; 116(1):56-65)

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Editorial

New Markers of Carotid Thickening in Hypertension

Rui Póvoa

Arterial hypertension was considered an important cardiovascular risk factor only after the Framingham studies, as it was believed that it was a necessary “good” for good tissue perfusion. These emblematic long-term cohort studies about the cardiovascular system brought data that allowed the evaluation of the interaction with several other diseases, such as dyslipidemias and diabetes, for the atheromatous plaque formation, which is the initial step for cardiovascular complications. A time when clinical examination was essential to detect markers of atherosclerotic disease.

However, with the evolution of knowledge, clinical biological markers were no longer sufficient to predict risk, as we increasingly need to articulate preventive measures as early as possible, for more effective treatment and better prevention. Additionally, the interaction between the environment, with all its risk factors and genetics proved to be interactive and of crucial importance in the development of the atherosclerotic plaque. Regarding hypertension, the genetic component with an estimated inheritance of 15-40% became clear, so much so that the brothers have a risk agreement rate for the disease ranging from 1.2 to 1.7.^,

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IJCS

Original Article

Analysis of Adherence to Antihypertensive Drug Treatment in an Argentinean Cohort

Walter Gaston Espeche et al. Rodrigo Sabio Alejandro Diaz Roberto Parodi … Carlos Enrique Leiva Sisnieguez Roberto Antonio Flores Silvia Poppe Javier Altube Diego Grimaldi Martin Rogelio Salazar

Abstract

Background

Adherence to antihypertensive medication is a major challenge in the management of hypertension, and non-adherence is an important barrier to effective management of hypertension.

Objectives

To determine the adherence rate to hypertensive drug treatment and the factors that influence non-adherence in a cohort of the Argentinean population.

Methods

A multicenter cross-sectional study was conducted in eight cities of Argentina. Consecutive hypertensive patients seen in general practice offices, receiving pharmacological treatment for at least six months were included. Blood pressure measurements were performed by physicians during the patient visit. The level of adherence was assessed using the Morisky questionnaire, and patients were divided into non-adherent and adherent. Continuous variables were compared using independent t-test. Categorical variables were compared using the χ² test. To identify the variables independently associated with non-adherence, a forward stepwise binary regression logistic model was performed, and the results expressed as odds ratio (OR) with 95% of confidence interval. All tests were two-tailed, and p-values < 0.05 were considered statistically significant.

Results

A total of 852 individuals (52% women, 62 ± 13 years) were included. The main reason for lack of adherence was forgetfulness of medication intake and errors in the time of intake (~ 40% in both). Individuals with more cardiovascular risk factors (smoking, diabetes, dyslipidemia and previous cardiovascular events) had lower adherence to antihypertensive treatment, and considerably younger (~ five years younger).

Conclusions

Adherence rate to antihypertensive drug treatment in our study group was higher than the one reported in previous studies, and the main reason for non-adherence was forgetfulness of medication intake. (Int J Cardiovasc Sci. 2020; 33(3):272-277)

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Editorial

Short Editorial: Hypertension in Special Populations: An Epidemiological Challenge

Rui Póvoa

Arterial hypertension (AH) is the most prevalent chronic disease worldwide and the main risk factor for most cardio-cerebrovascular diseases. The true prevalence in Brazil is still unknown, and the available data are from the Vigitel Study, where the information is obtained by telephone contact. The prevalence of hypertension in Brazil is estimated at around 31% in adult individuals. In recent data from the Vigitel Study, the prevalence was 25.7% of the adult Brazilian population. Knowledge of the real prevalence and geographic distribution is not only important for prevention and treatment measures, but also contribute to the knowledge of the genesis of the disease.

In some populations, particularly individuals of African descent, AH has its own characteristics, including prevalence, therapeutic response and severity.^, The multifactorial aspect of AH is only understood when assessing special populations considering their own habitats and habits, as in the case of quilombolas, where individuals with African ancestry still retain some genetic and cultural characteristics of the African origin. The analysis in this context is important, since we can detect aspects inherent to factors related to AH development.

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Original Article

Hypertension Prevalence, Treatment and Control in Older Adults in a Brazilian Capital City

Ana Luiza Lima Sousa et al. Sandro Rodrigues Batista Andrea Cristina Sousa Jade Alves S. Pacheco … Priscila Valverde de Oliveira Vitorino Valéria Pagotto

Abstract

Background:

The diagnosis, treatment and control of arterial hypertension are fundamental for a reduction in cardiovascular outcomes, especially in the elderly. In Brazil, there are few studies that specifically identified these rates in the elderly population.

Objective:

To verify rates of prevalence, treatment and control of hypertension in elderly people living in the urban area of a Brazilian capital city.

Methods:

A cross-sectional, population-based, randomized, cluster-based study with 912 non-institutionalized elderly individuals (≥ 60 years), living in urban areas in the city of Goiania, Midwest Brazil. Predictor variables were: age, gender, socioeconomic and lifestyle aspects. Blood pressure measurements were performed at home; patients were considered as having arterial hypertension when SBP and/or DBP ≥ 140/90 mmHg or when using antihypertensive drugs (dependent variable). Rates of hypertension treatment and control were evaluated. Variable association analyses were performed by multivariate logistic regression and level of significance was set at 5%.

Results:

The prevalence of arterial hypertension was 74.9%, being higher (78.6%) in men (OR 1.4, 95% CI: 1.04-1.92); the treatment rate was 72.6%, with higher rates being observed in smokers (OR 2.06, 95% CI: 1.28-3.33). The rate of hypertension control was 50.8%,being higher in women (OR 1.57, 95% CI: 1.19-2.08).

Conclusion:

The prevalence rates were high. Treatment and control rates were low and associated with gender, age and lifestyle, indicating the need for early and individual interventions.

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IJCS

Original Article

Spatial Analysis and Mortality Trends Associated with Hypertensive Diseases in the States and Regions of Brazil from 2010 to 2014

Marcos Antonio Almeida-Santos et al. Beatriz Santana Prado Deyse Mirelle Souza Santos

Abstract

Background:

Systemic Arterial Hypertension (SAH) represents the most relevant worsening factor and one of the major risk factors for cardiovascular diseases.

Objectives:

To analyze trends in the mortality rate associated with hypertensive diseases in Brazil from 2010 to 2014, for states as well as regions.

Methods:

An epidemiological study was performed from aggregate data obtained in populational strata. Cartographic data of the Brazilian territory in “shapefile” were provided by IBGE. Records of mortality associated with arterial hypertension were obtained in DATASUS, through notifications filtered by category I.10 of the International Classification of Diseases (ICD-10). The criterion of statistical significance was a two-tailed p-value < 0.05.

Results:

The increase in age was progressively associated with an increase in the mean number of deaths related to hypertensive diseases between the years 2010 and 2014. In the age groups between 50-59 years, 60-69 years, 70-79 years and 80 or more years, the mean and standard deviation for the mortality rate were, respectively: 15.11% (35.35); 24.14% (55.34); 35.07% (81.03) and 57.87% (139.08). The overall mortality rate per 10,000 inhabitants varied between the regions: north (1.25); northeast (2.69); center-west (2.06); southeast (2.48) and south (2.04).

Conclusions:

The mortality rate associated with hypertensive diseases was higher in the southeastern and northeastern states of Brazil, and remained stable between 2010 and 2014. Increased age and brown color were predictors of higher mortality.

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IJCS

Original Article

High Blood Pressure in Pre-Adolescents and Adolescents in Petrópolis: Prevalence and Correlation with Overweight and Obesity

Flavio Figueirinha et al. Gesmar Volga Haddad Herdy

Abstract

Background:

Arterial hypertension is a multisystem disease that increases the risk of fatal cardiac events.

Objectives:

This study aims to determine the prevalence of increased blood pressure levels of pre-adolescents and adolescents and correlate these pressure levels with the presence of overweight or obesity and family history of hypertension.

Methods:

In an observational, cross-sectional study, a sample of 157 students from the city of Petropolis aged from ten to nineteen was randomly selected. The study included four public schools and one private school. The persons responsible for each student answered a questionnaire on pre-existing conditions, family history of hypertension and previous blood pressure measurements. A thorough physical examination, anthropometric evaluation and two blood pressure readings were taken at intervals of at least ten minutes, on three different occasions, totaling six measurements.

Results:

Blood pressure levels have shown to be abnormal in 17 (10.8% / IC95% 5.9-15.7) studied individuals. Statistical significance was found between the change in blood pressure and the presence of overweight and obesity (p < 0.001), as well as with the presence of family history of hypertension (p < 0.05). A portion of 32.5% of the subjects had never had their blood pressure measured, and over the twelve months prior to the study, 45.5% of the sample had not measured it either.

Conclusions:

This study demonstrated that a significant percentage of students in the city of Petrópolis, in the state of Rio de Janeiro, has high blood pressure with a statistically significant correlation with overweight or obesity and a family history of hypertension.

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IJCS

Original Article

Prevalence of Hypertension in Children from Public Schools

Camila Brandão de Souza et al. Cláudia de Souza Dourado José Geraldo Mill Luciane Bresciane Salaroli Maria del Carmen Bisi Molina

Abstract

Background:

There is a discrepancy between protocols used for the diagnosis of childhood hypertension, and the most recommended one is the measurement of blood pressure in at least three different moments.

Objective:

To identify the prevalence of hypertension in children, and to associate it with the nutritional status variable.

Methods:

This is a longitudinal study, which included all children aged 7 to 10 years enrolled in public schools and had the authorization of their parents/guardians, totaling 722 children. In the first evaluation, the child’s family answered a questionnaire, and the child was submitted to anthropometric and hemodynamic evaluation. Blood pressure was measured three times at three different times. Children who had high blood pressure at the first moment were reassessed at a second time; those who persisted with high blood pressure were re-evaluated at a third moment.

Results:

The prevalence of high blood pressure at the first moment was 8.1%, being 3.2% in the second and 2.1% in the third. The nutritional status was significantly associated with the increase in systolic and diastolic blood pressures, being higher in overweight and obese children. The highest prevalence of high blood pressure was found in children classified as obese, at all moments.

Conclusion:

By performing blood pressure measurements of children at different moments, it was possible to reduce false-positive cases for arterial hypertension. The nutritional status was directly associated with the increase in blood pressure values. Performing the measurements in routine consultations becomes essential for diagnosis and early intervention.

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Original Article

Matricial Support and Arterial Hypertension Control

Clóvis Hoepfner et al. Morgana Longo Andressa de Oliveira Coiradas Laíssa Mara Rodrigues Teixeira

Abstract

Background:

A continuing education program for health professionals improves their performance and increases hypertension control rates.

Objective:

To estimate the prevalence of hypertension control and therapeutic inertia among adults treated at Primary Health Care Units after a continuing education program focused on cardiology for health professionals.

Methods:

A cross-sectional study was carried out, which included cluster sampling and analysis of medical records. We evaluated 463 patients with high blood pressure and analyzed the blood pressure, medications, and therapeutic increments in 2013, which were compared to the data obtained in 2007.

Results:

There was prevalence of female patients and appointments at the Family Health Care Units. The age ranged between 24 and 92 years (mean of 61.7 years). There was a reduction in the mean blood pressure (148.62/91.60 ± 23.52/14.51 mmHg to 137.60/84.03 ± 21.84/12.72) between the first and last records, and BP control in 58% of the sample, that is, higher than the 36.6% found in 2007. In the analyzed period, there was a therapeutic increment of 39% in appointments, which benefited 52% patients with high blood pressure, higher than the 12% and 29.5%, respectively, found in 2007. The mean number of drugs per patient increased from 1.85 to 2.05, with a predominance of diuretics and angiotensin-converting-enzyme inhibitors.

Conclusion:

There was a reduction in the clinical inertia and increased control of arterial hypertension was observed, compared with the findings of the previous study. The result suggests that the matricial support program for health professionals and other measures to improve disease control in the Primary Health Care Units were effective.

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Original Article

Blood Pressure Control in Hypertensive Patients in the "Hiperdia Program": A Territory-Based Study

Clarita Silva de Souza et al. Airton Tetelbom Stein Gisele Alsina Nader Bastos Lucia Campos Pellanda

Background:

Systemic hypertension is highly prevalent and an important risk factor for cardiovascular events. Blood pressure control in hypertensive patients enrolled in the Hiperdia Program, a program of the Single Health System for the follow-up and monitoring of hypertensive patients, is still far below the desired level.

Objective:

To describe the epidemiological profile and to assess blood pressure control of patients enrolled in Hiperdia, in the city of Novo Hamburgo (State of Rio Grande do Sul, Brazil).

Methods:

Cross-sectional study with a stratified cluster random sample, including 383 adults enrolled in the Hiperdia Program of the 15 Basic Health Units of the city of Porto Alegre, conducted between 2010 and 2011. Controlled blood pressure was defined as ≤140 mmHg × 90 mmHg. The hypertensive patients were interviewed and their blood pressure was measured using a calibrated aneroid device. Prevalence ratios (PR) with 95% confidence interval, Wald’s χ² test, and simple and multiple Poisson regression were used in the statistical analysis.

Results:

The mean age was 63 ± 10 years, and most of the patients were females belonging to social class C, with a low level of education, a sedentary lifestyle, and family history positive for systemic hypertension. Diabetes mellitus (DM) was observed in 31%; adherence to the antihypertensive treatment in 54.3%; and 33.7% had their blood pressure controlled. DM was strongly associated with inadequate BP control, with only 15.7% of the diabetics showing BP considered as controlled.

Conclusion:

Even for hypertensive patients enrolled in the Hiperdia Program, BP control is not satisfactorily reached or sustained. Diabetic hypertensive patients show the most inappropriate BP control.

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