Hypertension Management in Brazil: Usual Practice in Primary Care—A Meta-Analysis

Abstract

Knowing the usual clinical practice is relevant for evaluations in health care and economic policies of management of hypertension. This study aimed to describe the usual management of hypertension in the Brazilian primary healthcare system through a systematic review and meta-analysis. The search of population-based studies conducted in Brazil was undertaken using PubMed, EMBASE, and Brazilian databases. Eligible studies were those conducted in adults with hypertension (blood pressure (BP) ≥ 140/90 mmHg or using BP lowering drugs). Three datasets' data were analyzed: SESI study (in Brazilian workers); HIPERDIA (Brazilian Registration and Monitoring of Hypertensive and Diabetic Patients Program); and a population-based study. Meta-analysis has been performed using the fixed and random effect models. A total of 11 studies or data sets were included in the systematic review. Hypertensive individuals had, on average, 2.6 medical visits annually and 18.2% were on diuretics (n = 811 hypertensive patients) and 16.2% on ACE inhibitors (n = 1768 hypertensive patients). BP control rate ranged from 43.7 to 67.5%; 35.5% had measured total cholesterol and 36.5% determined fasting plasma glucose in the previous 12 months. Thiazide diuretics and ACE inhibitors were the most used BP lowering medications as single drugs, but the control rate of hypertension is insufficient.

Trends in prevalence, mortality and morbidity associated with high systolic blood pressure in Brazil from 1990 to 2017: estimates from the “Global Burden of Disease 2017” (GBD2017) study

“…In comparison to other BRICS countries, the mortality rate per 100,000 inhabitants attributable to HSBP between 1990 and 2017 decreased 45% in Brazil and 24% in Russia, while it practically did not change in the other countries -with even an increasing trend in South Africa -over the period. This nding also suggests the relative e ciency of the large-scale health policies implemented in the country for HTN control, such as established follow-up protocols and multidisciplinary approach for HTN care in the primary health setting, along with free access to antihypertensives [6,8]. However, among other countries with universal access to health such as Canada and England, we nd attributable mortality rates to be about half those observed in Brazil in 2017.…”

“…This concern is even more compelling in regions with moderate to good access to medications, where patients under treatment with SBP levels below 140 mmHg will not meet the cutoff derived from the GBD continuous estimation of systolic BP. Most previous population-based studies [1,8,10] used as the diagnostic criteria the presence of blood pressure (BP) ≥140/90 mmHg or the use of BP lowering medication, which necessarily led to a higher prevalence than observed in GBD. Indeed, a meta-analysis from 2012 showed a mean prevalence of HTN of 28.7% (26.2-31.4%) for decade of 2000´s [22], while the National Health Survey 2013 (adults >18 years-old) showed a general prevalence of 32.3% considering direct measurement and/or reported use of medication, contrasting with 21.4% for self-reporting and 22.8% for measured HTN [3].…”

“…Of note, only in Rio Grande do Sul and Santa Catarina there was no variation or even a slight reduction trend in this period, considering the UIs. In the VIGITEL telephone survey, the prevalence of self-reported medical diagnosis of HTN did not change from 2006 to 2017 [20] -but a non-signi cant increasing trend in the past years was observed -while a previous meta-analysis of population-based studies showed a trend toward decreasing prevalence from 1987 to 2007 [8]. able to give a de nite response for this question.…”

“…More than access to medical appointments, adequate long-term HTN control is highly dependent on population education to improve awareness and health promotion through a multidisciplinary approach, as well as improvement of the quality of care [6]. In part, this is the scope of the Family Health program that has been developed in the Brazilian primary care system since the 1990s, that should be further promoted [8]. Although it is necessary to provide universal access and high-quality healthcare, it is mandatory to also act on social determinants of health to sustainably reduce the burden of CVD [41].…”

Profile of patients with hypertension and/or diabetes mellitus from Primary Healthcare units

“…(4) Similarly, among patients with hypertension who were registered in followingup and recording system of arterial hypertension and diabetes mellitus of the Brazilian Public Health System, around 22% to 25% of them also had diabetes. (5) In public health policy, Primary Health Care (PHC) is considered the main entrance and communication center with users in healthcare network. (6) With regard to chronic diseases, the PHC is responsible, among other actions, for screening, diagnosis and treatment, and should also prevent, diagnosis, and treat possible complications early and coordinate the integral and continuous care of these patients.…”