Arterial hypertension and associated factors: National Health Survey, 2019 / Hipertensão arterial e fatores associados: Pesquisa Nacional de Saúde, 2019

ABSTRACT OBJECTIVE To analyze the factors associated with self-reported arterial hypertension, as well as its prevalence in the Brazilian adult population. METHODS Data from 88,531 individuals aged 18 years or older who responded to the 2019 National Health Survey were analyzed. The outcome studied was self-reported arterial hypertension. Sociodemographic variables and clinical and lifestyle conditions were considered as exposures. The prevalence ratio (PR), crude and adjusted for sex, age, and schooling was used as a measure of association to verify the factors related to its prevalence, obtained by Poisson regression with robust variance. RESULTS The prevalence of self-reported arterial hypertension was of 23.9% (95%CI: 23.4-24.4). When adjusting for age, sex, and schooling, the adjusted Prevalence Ratios (APR) were higher among: regular health self-assessment (APR = 1.6; 95%CI: 1.5-1.6) and bad health self-assessment (APR = 1.7; 95%CI: 1.6-1.8); self-reference to heart disease (APR = 1.7; 95%CI: 1.6-1.7), diabetes (APR = 1.7; 95%CI: 1.6-1.8), high cholesterol (APR = 1.6; 95%CI: 1.6-1.7), overweight (APR = 1.4; 95%CI: 1.4-1.5), and obesity (APR = 2.0; 95%CI: 1.9-2.1); high salt intake (APR = 1.1; 95%CI: 1.0-1.1); higher among former smokers (APR = 1.1; 95%CI: 1.1-1.2) and lower among smokers (APR = 0.9; 95%CI: 0.8-0.9); and consumption of ultra-processed foods (APR = 0.9; 95%CI: 0.8-0.9). CONCLUSION A quarter of the Brazilian adult population claims to have arterial hypertension, more prevalent among women and associated with older age groups, Black, mixed-race, and others, low schooling, high salt intake, former smoking, presence of comorbidities, and worse health self-assessment.

RESUMO OBJETIVO Analisar os fatores associados à hipertensão arterial autorreferida, bem como sua prevalência, na população de adultos brasileiros. MÉTODOS Foram analisados dados de 88.531 indivíduos de 18 anos ou mais que responderam à Pesquisa Nacional de Saúde de 2019. O desfecho estudado foi a hipertensão arterial autorreferida. Como exposições, foram consideradas variáveis sociodemográficas, condições clínicas e de estilo de vida. Para verificar os fatores associados à prevalência, usou-se como medida de associação a razão de prevalência (RP) bruta e ajustada por sexo, idade e escolaridade, obtidas por meio da Regressão de Poisson com variância robusta. RESULTADOS A prevalência da hipertensão arterial autorreferida foi de 23,9% (IC95% 23,4-24,4). Ao ajustar por idade, sexo e escolaridade, as Razões de Prevalência ajustadas (RPaj) foram mais elevadas entre: auto avaliação de saúde regular (RPaj = 1,6; IC95% 1,5-1,6) e ruim (RPaj = 1,7; IC95% 1,6-1,8); autorreferência a doença do coração (RPaj = 1,7; IC95% 1,6-1,7), diabetes (RPaj = 1,7; IC95% 1,6-1,8), colesterol elevado (RPaj = 1,6; IC95% 1,6-1,7), sobrepeso (RPaj = 1,4; IC95% 1,4-1,5) e obesidade (RPaj = 2,0; IC95% 1,9-2,1); consumo elevado de sal (RPaj = 1,1; IC95% 1,0-1,1); entre ex-fumantes (RPaj = 1,1; IC95% 1,1-1,2) e menor entre fumantes (RPaj = 0,9; IC95% 0,8-0,9) e consumo de alimentos ultraprocessados (RPaj = 0,9; IC95% 0,8-0,9). CONCLUSÃO Um quarto da população adulta brasileira afirma ter hipertensão arterial, de forma mais prevalente entre as mulheres e associada às maiores faixas etárias, cor da pele/raça preta, parda e outras, baixa escolaridade, consumo elevado de sal, ex-tabagismo, presença de comorbidades e pior autoavaliação de saúde.

La hipertensión arterial en Cuba según la Encuesta Nacional de Salud 2018-2019

Introducción: La hipertensión arterial es una condición médica grave que aumenta significativamente los riesgos de enfermedades cardiovasculares y otras. La mayoría de personas hipertensas ignoran que lo son. Es muy importante medir la presión arterial de manera periódica, es la única forma de detectar la enfermedad. Objetivo: Valorar indicadores de morbilidad por hipertensión arterial y pre hipertensión en el país, a partir de los hallazgos de la prevalencia, tratamiento y control de la enfermedad dados por Encuesta Nacional de Salud, concluida en el año 2019. Métodos: Como parte de la Encuesta Nacional de Salud, Cuba 2018-2019, se realizó un estudio transversal, con el objetivo de identificar la prevalencia de hipertensión arterial, según las variables sociodemográficas, zona geográfica de residencia, en el momento del diagnóstico; el manejo y control de los hipertensos conocidos y la clasificación de los nuevos hipertensos según las cifras sisto/diastólicas presentadas en el momento del diagnóstico. Incluyó a población de 15 años y más, residentes en zonas urbanas y rurales. Resultados: La prevalencia de hipertensión arterial en Cuba fue de 37,3 %, superior en las mujeres con 40,2 %, tanto a nivel global como en las áreas geográficas urbana y rural. Predominaron los hipertensos de ambos sexos en las áreas urbanas. Se incrementó la hipertensión en la medida que lo hizo la edad. Conclusiones: Existió un incremento en la prevalencia total de hipertensión arterial en Cuba en los últimos 24 años. Esta fue superior a la dispensarización reportada a nivel nacional en el primer nivel de atención de salud.

Introduction: High blood pressure is a serious medical condition that significantly increases the risks of cardiovascular and other diseases. Most hypertensive people are unaware that they are. It is very important to measure blood pressure periodically, it is the only way to detect the disease. Objective: To assess indicators of morbidity due to hypertension and pre-hypertension in the country, based on the findings of the prevalence, treatment and control of the disease given by the National Health Survey, concluded in 2019. Methods: As part of the National Health Survey, Cuba 2018-2019, a cross-sectional study was carried out, with the aim of identifying the prevalence of high blood pressure, according to sociodemographic variables, geographic area of ​​residence, at the time of diagnosis; the management and control of known hypertensive patients and the classification of new hypertensive patients according to the systolic/diastolic figures presented at the time of diagnosis. It included the population aged 15 and over, residing in urban and rural areas. Results: The prevalence of arterial hypertension in Cuba was 37.3 %, higher in women with 40.2 %, both globally and in urban and rural geographic areas. Hypertensive patients of both sexes predominated in urban areas. Hypertension increased as age did. Conclusions: There was an increase in the total prevalence of arterial hypertension in Cuba in the last 24 years. This was higher than the dispensarization reported at the national level in the first level of health care.

Prevalence, awareness, treatment, and control of hypertension in Northern China: a cross-sectional study.

BACKGROUND: Hypertension has always been a worldwide health concern. The purpose of this study was to investigate the prevalence, awareness, treatment, and control rates of hypertension among adult residents of northern China, where people usually have a high-fat, high-salt diet and heavy alcohol consumption. METHODS: Through the Early Screening and Comprehensive Intervention Project for High Risk Groups of Cardiovascular Diseases in the Inner Mongolia of northern China, we collected data of 70,380 residents, from September 2015 to June 2017. We assessed the prevalence, awareness, treatment, and control of hypertension in the total population and sub-populations. Multivariable logistic regression analyses were used to identify the factors associated with the prevalence and control of hypertension. RESULTS: Among participants, only 13.4% had optimal blood pressure levels. About 55.7% (95% confidence interval (CI) = 55.3-56.1%) of the participants had hypertension. In addition, the awareness, treatment, control and control under-treatment rate of hypertension were 52.8% (95%CI = 52.3-53.3%), 43.3% (95%CI = 42.8-43.8%), 8.6% (95%CI = 8.3-8.9%) and 19.8% (95%CI = 19.2-20.4%), respectively. Multivariable logistic regression showed that older, male, Han, living in rural areas, current drinker, not married, lower educational level, lower annual income, diabetes, obesity, and dyslipidemia were more likely to be suffered from hypertension (P < 0.05). Controlled hypertension was less common in those younger, Mongol, not married, farmer, current drinker, lower educational level, obesity, diabetes, without prior CHD, and without prior CVD (P < 0.05). CONCLUSION: Among populations aged 35-75 years in Northern China, more than half have hypertension, fewer than one-tenth have successfully controlled hypertension, and fewer than one-fifth of hypertension patients receiving treatment have controlled hypertension.

Expressão de Proteína-1 Relacionada a Receptor de Lipoproteína de Baixa Densidade (LRP1) em Monócito em Correlação com EIMC em Pacientes Mexicanos Hipertensos / Monocyte Low-Density Lipoprotein Receptor-Related Protein 1 (LRP1) Expression Correlates with cIMT in Mexican Hypertensive Patients

Resumo Fundamento A hipertensão arterial (HTA) representa um grande fator de risco de morbidade e mortalidade cardiovascular. Ainda não se sabe que mecanismos moleculares específicos estão associados ao desenvolvimento de hipertensão essencial. Objetivo Neste trabalho, analisamos a associação entre expressão mRNA de monócito LRP1, expressão de proteína LRP1, e espessura íntima-média de carótida (EIMC) de pacientes com hipertensão essencial. Métodos A expressão mRNA de monócito LRP1 e os níveis de proteína e EIMC foram quantificados em 200 indivíduos mexicanos, sendo 91 normotensos (NT) e 109 hipertensos (HT) A significância estatística foi definida em p < 0,05. Resultados O grupo de pacientes HT tinha EIMC maior altamente significativa em comparação com os pacientes NT (p = 0,002), e isso está relacionado ao aumento na expressão mRNA de LRP1 (6,54 versus. 2,87) (p = 0,002) e expressão de proteína LRP1 (17,83 versus 6,25), respectivamente (p = 0,001). Essas diferenças foram mantidas mesmo quando dividimos nossos grupos de estudo, levando em consideração apenas aqueles que apresentavam dislipidemia na expressão de mRNA (p = 0,041) e de proteínas (p < 0,001). Também se identificou que a indução de LRP1 mediada por LRP1 em monócitos em de maneira dependente de dose e tempo, com diferença significativa em NT versus HT (0,195 ± 0,09 versus 0,226 ± 0,12, p = 0,046). Conclusão Foi encontrado um aumento em EIMC em indivíduos com hipertensão, associada a expressões de proteína LRP1 e mRNA mais altas em monócitos, independente da presença de dislipidemia em pacientes HT. Esses resultados que a upregulation de LRP1 em monócitos de pacientes hipertensos mexicanos poderia estar envolvida na diminuição da EIMC. (Arq Bras Cardiol. 2021; 116(1):56-65)

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)

Hypertension prevalence, awareness, treatment, and control and predicted 10-year CVD risk: a cross-sectional study of seven communities in East and West Africa (SevenCEWA).

BACKGROUND: Few studies have characterized the epidemiology and management of hypertension across several communities with comparable methodologies in sub-Saharan Africa. We assessed prevalence, awareness, treatment, and control of hypertension and predicted 10-year cardiovascular disease risk across seven sites in East and West Africa. METHODS: Between June and August 2018, we conducted household surveys among adults aged 18 years and above in 7 communities in Kenya, Nigeria, Tanzania, and Uganda. Following a standardized protocol, we collected data on socio-demographics, health insurance, and healthcare utilization; and measured blood pressure using digital blood pressure monitors. We estimated the 10-year cardiovascular disease (CVD) risk using a country-specific risk score and fitted hierarchical models to identify determinants of hypertension prevalence, awareness, and treatment. RESULTS: We analyzed data of 3549 participants. The mean age was 39·7 years (SD 15·4), 60·5% of whom were women, 9·6% had ever smoked cigarettes, and 32·7% were overweight/obese. A quarter of the participants (25·4%) had hypertension, more than a half of whom (57·2%) were aware that they had diagnosed hypertension. Among those diagnosed, 50·5% were taking medication, and among those taking medication 47·3% had controlled blood pressure. After adjusting for other determinants, older age was associated with increased hypertension prevalence, awareness, and treatment whereas primary education was associated with lower hypertension prevalence. Health insurance was associated with lower hypertension prevalence and higher chances of treatment. Median predicted 10-yr CVD risk across sites was 4·9% (Interquartile range (IQR), 2·4%, 10·3%) and 13·2% had predicted 10-year CVD risk of 20% or greater while 7·1% had predicted 10-year CVD risk of > 30%. CONCLUSION: In seven communities in east and west Africa, a quarter of participants had hypertension, about 40% were unaware, half of those aware were treated, and half of those treated had controlled blood pressure. The 10-year predicted CVD risk was low across sites. Access to health insurance is needed to improve awareness, treatment, and control of hypertension in sub-Saharan Africa.

Analysis of Adherence to Antihypertensive Drug Treatment in an Argentinean Cohort

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)

Analysis of the interrelationships between factors influencing blood pressure in adults / Análise das inter-relações entre os fatores que influenciam a pressão arterial em adultos

ABSTRACT OBJECTIVE To investigate the interrelationships between sociodemographic, behavioral and clinical factors associated with high blood pressure in a population of Brazilian adults. METHODS Data from a cross-sectional population-based study conducted with adults were used. In the hypothetical model developed socioeconomic status, fruit and vegetable intake, adiposity and blood pressure were treated as latent variables and age, gender, glycemia, physical activity, smoking, alcohol consumption and control of arterial hypertension were considered observed variables. Confirmatory factorial analysis was used to construct the latent variables measurement models and the structural equation modeling was used to adjust the final model. RESULTS The study included 808 individuals, with mean age of 44.2 years (± 17.8), 52.7% being female. It verified that age exerted a positive direct effect on blood pressure (β = 0.39), adiposity (β = 0.44), glycemia (β = 0.26) and smoking (β = 0.30). Age had a negative direct effect on physical activity (β=-0.17) and alcohol consumption (β = -0.10). Males were positively associated with blood pressure (β = 0.13), smoking (β = 0.28; p < 0.001) and alcohol consumption (β = 0.18). Adiposity had a positive direct effect on blood pressure (β = 0.23) and glycemia (β = 0.16) and alcohol consumption produced a positive effect (β = 0.09) on adiposity. Fruit and vegetable intake had a negative direct effect on blood pressure (β = -0.11), while socioeconomic status had a positive direct effect on fruit and vegetable consumption (β = 0.47). We adjusted the structural model according to the variable medical control of arterial hypertension, which had a negative direct effect on blood pressure (β = -0.10). CONCLUSIONS Results suggest that increasing age is associated with increased blood pressure, adiposity, glycemia and smoking, as well as with reduced physical activity and alcohol consumption. Males were associated with increased blood pressure and greater use of alcohol and cigarettes. Higher adiposity indicators were correlated with increased blood pressure and glycemic levels; higher alcohol consumption was associated with increased adiposity. Higher consumption of fruits and vegetables, as well as active control of hypertension were associated with reduced blood pressure. Better socioeconomic status was associated with higher consumption of fruits and vegetables.

RESUMO OBJETIVO Investigar as inter-relações entre fatores sociodemográficos, comportamentais e clínicos associados à elevação da pressão arterial em adultos. MÉTODOS Utilizaram-se dados de um estudo transversal de base populacional. Foi desenvolvido um modelo hipotético em que condição socioeconômica, consumo de frutas e vegetais, adiposidade e pressão arterial foram tratadas como variáveis latentes, e idade, sexo, glicemia, atividade física, tabagismo, consumo de álcool e controle da hipertensão arterial (HA) foram tratadas como variáveis observadas. Utilizou-se a modelagem de equação estrutural para ajustar o modelo final. RESULTADOS Participaram do estudo 808 indivíduos, com idade média de 44,2 anos (DP = 17,8), sendo 52,7% do sexo feminino. Verificou-se que a idade exerceu efeito positivo sobre pressão arterial (β = 0,39), adiposidade (β = 0,44), glicemia (β = 0,26) e tabagismo (β = 0,30), e efeito negativo sobre atividade física (β = -0,17) e consumo de álcool (β = -0,09). O sexo masculino mostrou-se associado positivamente com a pressão arterial (β = 0,13), com o tabagismo (β = 0,28) e com o consumo de bebida alcoólica (β = 0,18). A adiposidade teve efeito positivo sobre a pressão arterial (β = 0,23) e a glicemia (β = 0,16), o consumo de álcool produziu efeito positivo sobre a adiposidade (β = 0,09), o consumo de frutas e vegetais exerceu efeito negativo sobre a pressão arterial (β = -0,11), e a condição socioeconômica teve efeito positivo sobre o consumo de frutas e vegetais (β = 0,47). O modelo estrutural foi ajustado pela variável controle médico da hipertensão, que apresentou efeito negativo sobre a pressão arterial (β = -0,10). CONCLUSÕES Os resultados sugerem que o aumento da idade se associa ao aumento da pressão arterial, adiposidade, glicemia e tabagismo, assim como com a redução da atividade física e consumo de álcool. O sexo masculino associou-se com aumento da pressão arterial e maior uso de bebida alcoólica e cigarros. A adiposidade correlaciona-se ao aumento da pressão arterial e da glicemia, enquanto maior consumo de álcool associa-se com aumento da adiposidade e maior consumo de frutas e vegetais, assim como o controle ativo da hipertensão, correlaciona-se com redução da pressão arterial. A melhor condição socioeconômica mostrou-se associada com maior consumo de frutas e vegetais.

Epidemiology of artherial hypertension in pregnants / Epidemiologia da hipertensão arterial em gestantes

ABSTRACT Objective To investigate the epidemiological data of hypertension in pregnant women, as well as to identify its possible associated events. Methods Data collection was performed at the high-risk prenatal outpatient clinic and in the maternity ward at a public hospital in the São Paulo city, during the morning and afternoon periods, from October 2015 to July 2016. A questionnaire with 22 questions prepared by the researchers was used. The margin of error was 5% and the confidence level was 95%. For the calculation, the two-proportion equality, Pearson correlation and ANOVA tests were used. Results Among the interviewees, 43% had chronic hypertension, 33.3% presented with up to 20 weeks of gestation, 23.7% presented after the 20th week of gestation, 62.3% were between 18 and 35 years of age, 78.1% had a family history of hypertension, and among those aged 36 to 45 years, 11.4% were in the first gestation, and 26.3% in the second gestation. Considering the associated conditions, diabetes prevailed with 50%; obesity with 22.2%, and the most selected foods for consumption among pregnant women, 47.5% had high energy content (processed/ultraprocessed). Conclusion After an epidemiological analysis of the prevalence of hypertension, pregnant women with chronic hypertension, preexisting hypertension diagnosed during pregnancy, and hypertensive disease of pregnancy were identified. Regarding the possible factors associated with arterial hypertension, higher age, family history of hypertension, preexistence of hypertension, late pregnancies, diabetes, obesity and frequent consumption of processed/ultraprocessed foods were found.

RESUMO Objetivo Pesquisar os dados epidemiológicos da hipertensão arterial em gestantes, bem como identificar seus possíveis eventos associados. Métodos A coleta de dados foi realizada no ambulatório do pré-natal de alto risco e na enfermaria da maternidade em hospital público da cidade de São Paulo, nos períodos matutino e vespertino, de outubro de 2015 a julho de 2016. Foi aplicado um questionário com 22 perguntas elaborado pelos pesquisadores. A margem de erro foi de 5% e o nível de confiança, de 95%. Para o cálculo, foram usados o teste de igualdade de duas proporções, a correlação de Pearson e o teste de ANOVA. Resultados Dentre as entrevistadas, 43% tinham hipertensão crônica, 33,3% se apresentaram com até 20 semanas de gestação, 23,7% se apresentaram após a 20ª semana da gestação, 62,3% tinham idade entre 18 e 35 anos, 78,1% tinham antecedente familiar com hipertensão arterial, 11,4% com idade entre 36 a 45 anos estavam na primeira gestação, e 26,3% com a mesma idade estavam a partir da segunda gestação. Dentre as afecções associadas, prevaleceu o diabetes com 50%; 22,2% se tratavam de obesidade, e dos alimentos mais escolhidos para consumo entre as gestantes, 47,5% possuíam alto teor energético (processados/ultraprocessados). Conclusão Após análise epidemiológica no resultado da prevalência da hipertensão arterial, foram encontradas gestantes com hipertensão arterial crônica, hipertensão arterial preexistente descoberta durante a gestação e doença hipertensiva específica da gestação. Em relação aos possíveis fatores associados à hipertensão arterial, foram encontrados: idade mais elevada, antecedentes familiares de hipertensão, preexistência de hipertensão, gestações tardias, diabetes, obesidade e frequente consumo de alimentos processados/ultraprocessados.

Multivariate analysis of hypertension in general US adults based on the 2017 ACC/AHA guideline: data from the national health and nutrition examination survey 1999 to 2016.

PURPOSE: Since the publication of the 2017 ACC/AHA hypertension guideline, few studies have analyzed the epidemiology and management of hypertension across many heterogeneous subgroups in the US. MATERIALS AND METHODS: We analyzed the data collected by the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2016. Participants greater than 20 years of age, who had valid blood pressure measurements, were included in the study. A comprehensive analysis of 14 population subgroups was done to systematically examine how hypertension awareness, treatment, and control varied by subpopulations. RESULTS: Our study included 45,557 participants with a mean age of 47.1 years, 48.3% were male and 51.7% were female. 47.8% participants had hypertension, of which 59.9% were aware of their diagnosis. Among the participants who were aware of their hypertension, 90.3% were prescribed medication(s) to lower blood pressure, of which 39.2% had achieved control. Multivariate analysis showed age, gender, Race/ethnicity, annual family income, education level, BMI, waist to height ratio, diabetes, and previous cardiovascular events to be independent risk factors for hypertension. Lower likelihoods of awareness and treatment were associated with male sex, younger age, Mexican ethnicity, participants without health insurance, absence of previous cardiovascular events, diabetes, obesity, or smoking. Overall, hypertension control rate was suboptimal across most of subgroups (<40%). CONCLUSION: Based on the 2017 ACC/AHA guideline, almost half of the US adult population has hypertension. The suboptimal number of people with controlled blood pressure is pervasive in all subgroups and warrants greater efforts in prevention, as well as more effective treatment.

Hypertension Prevalence, Treatment and Control in Older Adults in a Brazilian Capital City / Prevalência, Tratamento e Controle da Hipertensão Arterial em Idosos de uma Capital Brasileira

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.

Resumo Fundamento: O diagnóstico, tratamento e controle da hipertensão arterial são fundamentais para a redução de eventos cardiovasculares, especialmente em idosos. No Brasil são escassos os estudos que identificaram essas taxas especificamente na população idosa. Objetivo: Verificar a prevalência, taxas de tratamento e controle da hipertensão arterial entre idosos da zona urbana de uma capital brasileira. Métodos: Estudo transversal de base populacional, com amostragem aleatória por conglomerado, realizado com 912 idosos (maiores de 60 anos), residentes na zona urbana de Goiânia. Variáveis preditoras: idade, sexo, aspectos socioeconômicos e estilo de vida. Medidas da pressão arterial (PA) realizada em domicílio; hipertensão arterial (HA) igual a PA sistólica e/ou diastólica maior ou igual a 140/90mmHg ou usando anti-hipertensivos (variável dependente). Foram avaliadas taxas de tratamento e controle de HA. Análise de associação dos desfechos com regressão logística multivariada e nível de significância de 5%. Resultados: Prevalência de hipertensão arterial total foi de 74,9%, sendo maior entre os homens 78,6% (OR 1,4; IC95%1,04-1,92); A taxa de tratamento foi de 72,6%, com taxas superiores entre os fumantes (OR 2,06; IC 95% 1,28-3,33). A taxa de controle total foi de 50,8%, maior entre as mulheres (OR 1,57; IC 95% 1,19- 2,08). Conclusões: As taxas de prevalência foram elevadas. Taxas de tratamento e controle foram baixas e mostraram associação com sexo, faixa etária e estilo de vida, indicando necessidade de intervenções precoces e individuais.

25-Year trends in hypertension prevalence, awareness, treatment, and control in an Indian urban population: Jaipur Heart Watch.

OBJECTIVES: We evaluated trends in hypertension prevalence, awareness, treatment and control in an Indian urban population over 25 years. Trends were projected to year 2030 to determine attainment of World Health Organization (WHO) Global Monitoring Framework targets. METHODS: Adult participants (n=7440, men 4237, women 3203) enrolled in successive population based studies in Jaipur, India from years 1991 to 2015 were evaluated for hypertension prevalence, awareness, treatment and control. The studies were performed in years 1991-93 (n=2212), 1999-01 (n=1123), 2003-04 (n=458), 2006-07 (n=1127), 2009-10 (n=739) and 2012-15 (n=1781). Descriptive statistics are reported. We used logarithmic forecasting to year 2030 and compared outcomes to WHO target of 25% lower prevalence and >50% control. RESULTS: The age-adjusted hypertension prevalence (%) among adults in successive studies increased from 29.5, 30.2, 36.5, 42.1, 34.4 to 36.1 (R2=0.41). Increasing trends were observed for hypertension awareness (13, 44, 49, 44, 49, 56; R2=0.63); treatment in all (9, 22, 38, 34, 41, 36; R2=0.68) and aware hypertensives (61, 66, 77, 79, 70, 64; R2=0.46); and control in all (2, 14, 13, 18, 21, 21; R2=0.82), aware (12, 33, 27, 46, 37, 37; R2=0.54) and treated (9, 20, 21, 48, 36, 49; R2=0.80) hypertensive participants. Projections to year 2030 show increases in prevalence to 44% (95% CI 43-45), awareness to 82% (81-83), treatment to 62% (61-63), and control to 36% (35-37). CONCLUSION: Hypertension prevalence, awareness, treatment and control rates are increasing among urban populations in India. Better awareness is associated with greater control. The rates of increase are off-target for WHO Global Monitoring Framework and UN Sustainable Development Goals.

Prevalence and Correlates of Hypertension among Japanese Adults, 1975 to 2010.

We investigated the prevalence and factors associated with hypertension, its treatment, and control using individual-level data from 300,249 respondents aged 20 years and older from the Japanese National Health and Nutrition Survey for the period of 1975⁻2010. We applied multivariate random effects logistic regression to assess associations between the risk factors and the prevalence of hypertension, the proportion of uncontrolled hypertension, and the proportions of respondents seeking treatment and controlling hypertension. The trends in the effect of the birth cohort on uncontrolled hypertension were also examined. Having hypertension was associated with being male, older, obese, drinking alcohol, and working in the primary industry and a higher proportion of middle-aged men than women were found being obese and drinking alcohol. Seeking treatment was associated with being older, obese, drinking alcohol, working in a primary industry and exercising. Controlling hypertension was associated with being younger, underweight and exercising. The proportion of individuals with uncontrolled hypertension declined for cohorts born in later years with a steeper decline for women than men. Raising awareness in the hypertensive population, especially among men, could help further reduce the prevalence of hypertension in Japan.

Challenges on the epidemiological and economic burden of diabetes and hypertension in Mexico / Retos sobre la carga epidemiológica y económica para diabetes e hipertensión en México

ABSTRACT OBJECTIVE To analyze the epidemiological and economic burden of the health services demand due to diabetes and hypertension in Mexico. METHODS Evaluation study based on a time series study that had as a universe of study the assured and uninsured population that demands health services from the three main institutions of the Health System in Mexico: The Health Department, the Mexican Institute of Social Security, and Institute of Services and Social Security for State Workers. The financing method was based on instrumentation and consensus techniques for medium case management. In order to estimate the epidemiological changes and financial requirements, a time series of observed cases for diabetes and hypertension 1994-2013 was integrated. Probabilistic models were developed based on the Box-Jenkins technique for the period of 2013-2018 with 95% confidence intervals and p < 0.05. RESULTS Comparing results from 2013 versus 2018, in the five regions, different incremental trends of 14%-17% in epidemiological changes and 58%-66% in the economic burden for both diseases were observed. CONCLUSIONS If the risk factors and the different models of care remained as they currently are in the three institutions analyzed, the financial consequences would be of greater impact for the Mexican Institute of Social Security, following in order of importance the Institute of Services and Social Security for State Workers and lastly the Health Department. The financial needs for both diseases will represent approximately 13%-15% of the total budget allocated to the uninsured population and 15%-17% for the population insured depending on the region.

RESUMEN OBJETIVO Analizar la carga epidemiológica y económica de la demanda de servicios de salud por diabetes e hipertensión en México. MÉTODOS Investigación evaluativa basada en un estudio de series de tiempo que tomó como universo de estudio la población asegurada y no asegurada que demanda servicios de salud a las tres principales instituciones del Sistema de Salud en México: Secretaría de Salud, Instituto Mexicano del Seguro Social, e Instituto de Servicios y Seguridad Social para los Trabajadores del Estado. El método de costeo tomó como base las técnicas de instrumentación y de consenso por manejo de caso promedio. Para estimar los cambios epidemiológicos y requerimientos financieros, se integró una serie de tiempos de casos observados para diabetes e hipertensión 1994-2013. Se desarrollaron modelos probabilísticos basados en la técnica de Box-Jenkins para el periodo 2013-2018 con intervalos del 95% de confianza y p < 0.05. RESULTADOS Comparando resultados de 2013 versus 2018, en las cinco regiones, se observaron diferentes tendencias incrementales de 14%-17% en cambios epidemiológicos y de 58%-66% en la carga económica para ambas enfermedades. CONCLUSIONES Si los factores de riesgo y los diferentes modelos de atención permanecieran como están actualmente en las tres instituciones de análisis, las consecuencias financieras serían de mayor impacto para el Instituto Mexicano del Seguro Social, siguiendo en orden de importancia el Instituto de Servicios y Seguridad Social para los Trabajadores del Estado y finalmente para la Secretaría de Salud. Los requerimientos financieros para ambas enfermedades representarán aproximadamente del 13%-15% del presupuesto total asignado para población no asegurada y el 15%-17% para población asegurada dependiendo de la región.

Association of Household Wealth Index, Educational Status, and Social Capital with Hypertension Awareness, Treatment, and Control in South Asia.

OBJECTIVE: Hypertension control rates are low in South Asia. To determine association of measures of socioeconomic status (wealth, education, and social capital) with hypertension awareness, treatment, and control among urban and rural subjects in these countries we performed the present study. METHODS: We enrolled 33,423 subjects aged 35-70 years (women 56%, rural 53%, low-education status 51%, low household wealth 25%, low-social capital 33%) in 150 communities in India, Pakistan, and Bangladesh during 2003-2009. Prevalence of hypertension and its awareness, treatment, and control status and their association with wealth, education, and social capital were determined. RESULTS: Age-, sex-, and location-adjusted prevalence of hypertension in men was 31.5% (23.9-40.2%) and women was 32.6% (24.9-41.5%) with variations in prevalence across study sites (urban 30-56%, rural 11-43%). Prevalence was significantly greater in urban locations, older subjects, and participants with more wealth, greater education, and lower social capital index. Hypertension awareness was in 40.4% (urban 45.9, rural 32.5), treatment in 31.9% (urban 37.6, rural 23.6), and control in 12.9% (urban 15.4, rural 9.3). Control was lower in men and younger subjects. Hypertension awareness, treatment, and control were significantly lower, respectively, in lowest vs. highest wealth index tertile (26.2 vs. 50.6%, 16.9 vs. 44.0%, and 6.9 vs. 17.3%, P < 0.001) and lowest vs. highest educational status tertile (31.2 vs. 48.4%, 21.8 vs. 42.1%, and 7.8 vs. 19.2%, P < 0.001) while insignificant differences were observed in lowest vs. highest social capital index (38.2 vs. 36.1%, 35.1 vs. 27.8%, and 12.5 vs. 9.1%). CONCLUSIONS: This study shows low hypertension awareness, treatment, and control in South Asia. Lower wealth and educational status are important in low hypertension awareness, treatment, and control.

Prevalence of and factors associated with self-reported high blood pressure in Brazilian adults / Prevalência e fatores associados com hipertensão arterial autorreferida em adultos brasileiros

ABSTRACT OBJECTIVE To analyze factors associated with self-reported high blood pressure among adults in Brazilian state capitals. METHODS The study uses data from Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel – Surveillance System of Risk and Protection Factors of Noncommunicable Diseases by Telephone Survey) collected in 2013. Prevalence rates and their respective 95% confidence intervals by gender were estimated according to sociodemographic variables, lifestyle, reported noncommunicable diseases and self-rated health status. Multivariate logistic regression modeling was used to identify variables associated with self-reported high blood pressure with α < 0.05. RESULTS Prevalence of self-reported high blood pressure among adults living in Brazilian state capitals and the Federal District was 24.1%. The following variables were associated with self-reported high blood pressure: age group, taking 18-24 as reference (all age groups presented increased risk – from 25-34 years [OR = 2.6; 95%CI 2.0–3.4] up to 65 years or more [OR = 28.1; 95%CI 21.7–36.4]); low education level (9 to 11 years of study [OR = 0.8; 95%CI 0.7–0.9] and 12 years or more [OR = 0.6; 95%CI 0.6–0.7]); Black race or skin color (OR = 1.3; 95%CI 1.1–1.5); being a former smoker (OR = 1.2; 95%CI 1.1–1.3); obesity (OR = 2.7; 95%CI 2.4–3.0); diabetes (OR = 2.9; 95%CI 2.5–3.5%), and high cholesterol (OR = 1.9; 95%CI 1.8–2.2). CONCLUSIONS Approximately one quarter of the adult population living in Brazilian state capitals reported having high blood pressure. Information from Vigitel is useful to monitor high blood pressure and identity its associated factors, supporting public policies for health promotion, surveillance and care.

RESUMO OBJETIVO Analisar os fatores associados à hipertensão arterial autorreferida entre adultos nas capitais brasileiras. MÉTODOS Estudo com os dados do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel) coletados no ano de 2013. Foram estimadas as prevalências e seus respectivos intervalos de confiança 95% por sexo segundo variáveis sociodemográficas, estilos de vida, doenças crônicas relatadas e avaliação do estado de saúde. Modelagem de regressão logística multivariada foi utilizada para identificar as variáveis associadas à hipertensão arterial autorreferida com α < 0,05. RESULTADOS A prevalência de hipertensão arterial autorreferida entre os adultos residentes nas capitais brasileiras e Distrito Federal foi de 24,1%. Foram identificadas as seguintes associações com hipertensão arterial autorreferida: faixa etária, tomando 18 a 24 anos como referência, todas as faixas etárias apresentaram maior chance – de 25 a 34 anos (RC = 2,6; IC95% 2,0–3,4) até 65 anos ou mais (RC = 28,1; IC95% 21,7–36,4); baixa escolaridade (9 a 11 anos de estudo – RC = 0,8; IC95% 0,7–0,9; e 12 anos ou mais – RC = 0,6; IC95% 0,6–0,7); raça/cor da pele preta (RC = 1,3; IC95% 1,1–1,5); ser ex-fumante (RC = 1,2; IC95% 1,1–1,3); obesidade (RC = 2,7; IC95% 2,4–3,0); diabetes (RC = 2,9; IC95% 2,5–3,5); e colesterol elevado (RC = 1,9; IC95% 1,8–2,2). CONCLUSÕES Cerca de um quarto da população adulta residente nas capitais brasileiras refere ter hipertensão arterial. As informações do Vigitel são úteis para o monitoramento da hipertensão arterial e identificação de seus fatores associados, subsidiando políticas públicas de promoção, vigilância e atenção à saúde.

Prevalencia de hipertensión pulmonar y factores asociados en adultos con insuficiencia mitral de una institución prestadora de servicios de salud de tercer nivel de la ciudad de Tunja / Prevalence of pulmonary hypertension and associated factors in adults with mitral regurgitation of a third level health services provider institution of Tunja city / Prevalência de hipertensão pulmonar e fatores associados em adultos com regurgitação mitral de uma instituição prestadora de serviços de saúde de terceiro nível na cidade de Tunja

Introducción. La hipertensión pulmonar es el aumento de la presión en las arterias pulmonares. Cuando la presión media en la arteria pulmonar sobrepasa los 25 mm Hg, se considera que existe hipertensión arterial pulmonar. Objetivo. Determinar la prevalencia y los factores asociados de la hipertensión pulmonar en adultos con insuficiencia mitral. Métodos. Se llevó a cabo un estudio de corte transversal que incluyó 676 pacientes mediante mues-treo no probabilístico de tipo censo, con diagnóstico de insuficiencia mitral comprobada mediante ecocardiografía, atendidos en un periodo de un año en una institución de tercer nivel de complejidad de Tunja. Se contó con autorización para el acceso y la revisión de las historias clínicas y los ecocar-diogramas. Resultados. La prevalencia de hipertensión pulmonar en pacientes con insuficiencia mitral fue de 42,9% El promedio de edad de los pacientes fue de 73,7 años y la proporción por sexo fue similar, con 50,7 % de mujeres y 49,3 % de hombres. Se encontró una asociación estadísticamente significativa de la variable enfermedad pulmonar obstructiva crónica con la de hipertensión pulmonar (OR ajustada de 1,82) (IC95% 1,2-2,7) y con la de falla cardiaca (OR ajustada de 3,01) (IC95% 1,7-5,3). Conclusiones. En los pacientes con insuficiencia mitral, se encontró una alta prevalencia de hiper-tensión pulmonar, situación que, según elementos clínicos, puede empeorar su pronóstico. Se halló una asociación estadísticamente significativa entre hipertensión pulmonar, y enfermedad pulmonar obstructiva crónica y falla cardiaca.

Introduction: Pulmonary hypertension is the increase in the pressure of the pulmonary arteries. When the average pressure in the pulmonary artery exceeds 25 mm Hg, it is considered to be associated with pulmonary arterial hypertension. Objective: To determine the prevalence and associated factors of pulmonary hypertension in adults with mitral insufficiency. Methods: A cross-sectional study of 676 patients with mitral insufficiency determined by echocar-diography performed in the one-year period in a third-level complexity institution of Tunja city was carried out. Access and review of clinical records and echocardiograms was authorized. A total of 676 patients was included using non-probabilistic sensorial type sampling. Results: A 42.9% prevalence of pulmonary hypertension was found in patients with mitral insuffi-ciency with a mean age of 73.7 years, the proportion of gender was similar, 50.7% in females and 49.3% in the male gender. A statistically significant association was found between chronic obstructi-ve pulmonary disease and pulmonary hypertension with an adjusted OR of 1.82 [95% CI: 1.24-2.66]; likewise, with heart failure with an adjusted OR of 3.01 [95% CI: 1.70-5.33]. Conclusions: A high prevalence of pulmonary hypertension was found in patients with mitral insu-fficiency, which according to clinical elements may worsen the prognosis of patients with this type of pathology. A statistically significant association was found in the population among pulmonary hypertension with chronic obstructive pulmonary disease or heart failure

Introdução. Hipertensão pulmonar é o aumento da pressão nas artérias pulmonares. Quando a pressão média na artéria pulmonar excede 25 mm Hg, considera-se a presencia da hipertensão arterial pulmonar. Objetivo. Determinar a prevalência e fatores associados à hipertensão pulmonar em adultos com regurgitação mitral. Métodos. Foi levado a cabo um estudo transversal que incluiu 676 pacientes com amostragem não probabilística de tipo censo, com diagnóstico de regurgitação mitral comprovada por ecocardiografia, atendido em um período de um ano em uma instituição de complexidade de terceiro nível em Tunja. Houve autorização para acesso e revisão de prontuários e ecocardiogramas. Resultados. A prevalência de hipertensão pulmonar em pacientes com regurgitação mitral foi de 42,9%. A média de idade dos pacientes foi de 73,7 anos e a proporção por sexo foi semelhante, com 50,7% das mulheres e 49,3% dos homens. Encontrou-se associação estatisticamente significativa entre a variável doença pulmonar obstrutiva crônica e hipertensão pulmonar (OR ajustada de 1,82) (IC95% 1,2-2,7) e com insuficiência cardíaca (OR ajustada de 3,01). (IC95% 1,7-5,3). Conclusões. Nos pacientes com regurgitação mitral, foi encontrada alta prevalência de hipertensão pulmonar, situação que, segundo os elementos clínicos, pode piorar seu prognóstico. Uma associação estatisticamente significativa foi encontrada entre hipertensão pulmonar, doença pulmonar obstrutiva crônica e insuficiência cardíaca.