Prevalence, Awareness, Treatment and Influence of Socioeconomic Variables on Control of High Blood Pressure: Results of the ELSA-Brasil Study

Abstract

High blood pressure (HBP) is the leading risk factor for years of life lost in Brazil. Factors associated with HBP awareness, treatment and control need to be understood better. Our aim is to estimate prevalence, awareness, and types of anti-hypertensive treatment and to investigate the association of HBP control with social position. Data of 15,103 (54% female) civil servants in six Brazilian state capitals collected at the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline (2008-2010) were used to estimate prevalence and cross-sectional association of HBP control with education, per capita family income and self-reported race, using multiple logistic regression. Blood pressure was measured by the oscillometric method. 35.8% were classified as presenting HBP; 76.8% of these used anti-hypertensive medication. Women were more aware than men (84.8% v. 75.8%) and more often using medication (83.1% v. 70.7%). Adjusted HBP prevalence was, in ascending order, Whites (30.3%), Browns (38.2%) and Blacks (49.3%). The therapeutic schemes most used were angiotensin-converting enzyme inhibitors, in isolation (12.4%) or combined with diuretics (13.3%). Among those in drug treatment, controlled blood pressure was more likely in the (postgraduate) higher education group than among participants with less than secondary school education (PR = 1.21; 95% CI: 1.14–1.28), and among Asian (PR = 1.21; 95% CI: 1.12–1.32) and ‘Whites (PR = 1.19; 95% CI: 1.12–1.26) compared to Blacks. Socioeconomic and racial inequality—as measured by different indicators—are strongly associated with HBP control, beyond the expected influence of health services access.

At the intersection of place, race, and health in Brazil: Residential segregation and cardio-metabolic risk factors in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

“…140 mmHg or diastolic BP ! 90 mmHg or use of antihypertensive medication in the last two weeks (Chor et al, 2015b). Systolic and diastolic blood pressure (BP) was measured during the baseline examination after a 5 min rest with the participant in a sitting position in a quiet, temperature-controlled room.…”

Prevalence of high blood pressure measured in the Brazilian population, National Health Survey, 2013

“…Moreover, among the individuals with high blood pressure, 80% were aware that they presented high blood pressure, 78% were undergoing treatment and 56% presented controlled levels. 10,11 In 2013, the National Health Survey (Pesquisa Nacional de Saúde, PNS) included blood pressure measurement among adults, along with questions about high blood pressure diagnosed by doctors, the care provided and use of medications, among other topics. 12,13 The present study is the first to analyze the high blood pressure data measured through the PNS in Brazil.…”

Targeting stroke risk and improving outcomes in patients with atrial fibrillation in Latin America

“…These are structural factors underlying global health inequalities that exceed the expected influence of access to health services. 30,35,36 Efforts to modify risk factors and alleviate the burden of stroke could be aided by economic and social improvements, including implementation of cost-effective public health policies. Enhanced surveillance efforts in outlier regions where there is a high stroke burden, particularly at low-and middle-income levels, could help to clarify factors implicated in the disproportionate stroke burden and guide interventions with specific goals.…”