Hypertension/prevention and control

ABC

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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IJCS

Original Article

The Challenges of Implementing a Text Message Intervention to Promote Behavioral Change in Primary Care Patients With Hypertension and Diabetes

João Antonio de Queiroz Oliveira et al. Christiane Cimini Vania Almeida Junia Xavier Maia … Raissa Eda Resende Leticia Alves Gualberto Pedro Henrique Lauar Santos Paulo R. Gomes Leonardo Bonisson Maria Cristina Paixão Janaina Moutinho Costa Clareci Silva Cardoso Karla Santo Antonio Ribeiro Maria Auxiliadora Martins Milena S. Marcolino

Abstract

Background

Controlling blood pressure and glycemic levels is a challenge that requires innovative solutions.

Objective

To assess the feasibility of implementing a text message intervention among low-income primary care patients, as well as to assess self-reported behavioral change.

Methods

A set of 200 text messages was developed on healthy eating, physical activity, adherence, and motivation. Participants from Vale do Mucuri, MG, Brazil diagnosed with diabetes or hypertension or undergoing screening for those diseases, received 5 to 8 messages per week for 6 months. They answered a questionnaire to report their satisfaction and behavioral changes.

Results

Of the 136 patients, 117 (86.0%) answered the questionnaire. Most reported that the messages were very useful (86.3%), easy to understand (90.6%), and were very helpful for behavioral change (65.0%); 84.6% reported that they had started eating healthier. The most frequent reported lifestyle changes were: improved diet quality (85.5%), reduced portions (65.8%), and weight loss (56.4%). The majority of patients shared the messages (60.7%) with family or other acquaintances, considered the number of messages to be adequate (89.7%) and would recommend the program to others (95.7%).

Conclusion

An intervention based on text messages to promote behavioral change in patients with hypertension or diabetes in primary care is feasible in low-resource settings. Future studies are needed to assess the program’s long-term effects on clinical outcomes.

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Editorial

COVID-19: A New Challenge in Pregnancy and Heart Disease

Walkiria Samuel Avila et al. Regina Coeli de Carvalho

The outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared a pandemic by the World Health Organization on March 11, 2020. Although SARS-CoV-2 isolation, gene sequencing, and structural analysis have been completed,therapies for COVID-19.

The first epidemiological data have pointed to a worse outcomes and higher mortality of COVID-19 in patients with chronic diseases, such as heart disease and arterial hypertension. Subsequently, the Brazilian Health Ministry included in the high-risk group pregnant, puerperal and post-abortion women.

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ABC

Editorial

Dietary Salt Reduction: Illusion or Reality?

Nereida Kilza da Costa Lima

In spite of ample knowledge regarding systemic arterial hypertension as the main risk factor for cardiovascular diseases, the rates of control have shown a modest progressive increase, especially in Brazil. Brazilian studies have provided evidence that 50% to 60% of people with hypertension are receiving treatment, while only 20% to 30% of all people with hypertension are controlled.

The main difficulty in controlling systemic arterial hypertension lies in managing long-term patient adherence, given that the majority of patients are asymptomatic, and they eventually begin to have symptoms as a result of antihypertensive medication use.

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IJCS

Editorial

The Challenge of Controlling Resistant Hypertension

Marcus Vinicius Bolivar Malachias

Hypertension is the main risk factor for cardiovascular disease, stroke, disability and death. Despite the accumulated knowledge about hypertension and many treatment options, some hypertensive patients do not achieve the recommended blood pressure goals even receiving non-pharmacological treatment and three antihypertensive drugs. These individuals have the so-called “resistant hypertension” and are at increased risk of involvement of target organs, higher morbidity and mortality.

Several international scientific societies, including the Brazilian Society of Cardiology, have dedicated to publishing evidence-based guidelines for the management of arterial hypertension,^, and specific position statements on resistant hypertension have also been produced.^, The Department of Hypertension of the Brazilian Society of Cardiology is about to issue an updated statement on the subject.

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ABC

Editorial

Self-Monitoring with or Without Telemonitoring: Is a New Time for Diagnosis and Management Hypertension?

Cibele Isaac Saad Rodrigues

According to the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline for the prevention, detection, evaluation, and management of high blood pressure (BP) in adults, 46% of US adults have hypertension (HTN). In Brazil, because the levels of systolic and diastolic BP that define HTN differ from ACC/AHA Guideline, the percentage is about 25%, according to VIGITEL.

HTN is an important public health issue and the major risk factor for heart disease, stroke, and chronic kidney disease. Heart disease and stroke are among the most prevalent and costly health problems worldwide, and controlling BP is the best effective intervention in life-saving, preventing deleterious comorbidities, but only about half of those with HTN have it under control even in developing countries.^,^,

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ABC

Editorial

Social Determinants of Hypertension

José Geraldo Mill

Hypertension (HT) is a disease with high prevalence in adults and is generally referred to as a ‘complex disease’. This term has been used to indicate the diversity of factors that contribute to its onset.^,

Studies in populations, twins, and families estimate that the impact of genetic background on the onset of HT ranges from 34% to 64%. However, pressure regulation depends on a multiplicity of organs, systems, and mechanisms, which is why a large number of genes affect individual values. As a result, genetic tests are still largely ineffective as predictors of HT, since monogenic inheritance of this disease is rare. Non-genetic factors are also numerous and are linked to lifestyle (nutrition, physical activity, alcohol and tobacco consumption, among others) or to the presence of conditions connected with a chronic inflammatory state, such as obesity and insulin resistance. In the presence of these factors, blood pressure increase with age is faster, leading to, at a given moment, blood pressure levels indicative of the presence of the disease. It is important to point out that the cutoffs that separate the states of ‘normotension’ and ‘hypertension’ are statistical, being suitable for use with populations, and potentially unsuitable in assessing individuals, as the disease may be present in a subclinical state, i.e., even before reaching diagnostic blood pressure levels obtained in epidemiological studies. Therefore, given the difficulty of using genetic data, disease prevention should be undertaken by identifying risk factors that contribute to raising blood pressure. In this context, epidemiological knowledge about specific populations is an essential tool for handling the disease.

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Original Article

Prevalence of Systemic Arterial Hypertension and Associated Factors Among Adults from the Semi-Arid Region of Pernambuco, Brazil

Emerson Rogério Costa Santiago et al. Alcides da Silva Diniz Juliana Souza Oliveira Vanessa Sá Leal … Maria Izabel Siqueira de Andrade Pedro Israel Cabral de Lira

Abstract

Background:

Systemic arterial hypertension is a substantial public health problem responsible for millions of deaths per year worldwide. However, little is known about the epidemiology of this disease in areas distant from large urban centers in Brazil. Such information is necessary to plan health promotion strategies.

Objective:

To estimate the prevalence of hypertension and determine its associated factors in adults residing in the semi-arid region of the state of Pernambuco, Northeastern Brazil.

Method:

This is a cross-sectional study conducted with a random sample of male and female adults. Individuals with systolic blood pressure ≥ 140 mm/Hg and/or diastolic blood pressure ≥ 90 mm/Hg and those who reported being under treatment with antihypertensive drugs were considered hypertensive. We collected data on demographic, socioeconomic, behavioral, and anthropometric characteristics, as well as health and nutrition. The statistical analysis used Pearson’s chi-square test, the chi-square test for trend, and multivariate Poisson regression analysis. A p-value < 0.05 in the final model was considered indicative of statistical significance.

Results:

The sample consisted of 416 individuals, and the prevalence of hypertension was 27.4% (95%CI 23.2 – 32.0). In the final model, the independent predictors of hypertension were age of 40 years or older (p = 0.000), low economic class (p = 0.007), smoking (p = 0.023), overweight determined by the body mass index (p = 0.003), and reduced glucose tolerance/diabetes mellitus (p = 0.012).

Conclusion:

The prevalence of hypertension was high and related to important risk factors. Thus, prevention and control strategies are recommended.

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ABC

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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