Abstract
To assess the evolution in prevalence, awareness and control of hypertension for over 10 years in Pernambuco State, Northeast Brazil, two cross-sectional studies were conducted based on random samples of households in urban and rural areas, in 2006 and 2015/2016, involving adults aged 20 years or older. Hypertension was defined as systolic blood pressure of at least 140mmHg or diastolic blood pressure of at least 90mmHg as well as the reported use of antihypertensive medication. A logistic regression analysis was conducted to estimate the influence of the social, behavioral and anthropometric determinants on hypertension. Although social and behavioral factors improved in this 10-year period, overweight and abdominal obesity increased. Approximately one third of the adult population of Pernambuco had hypertension in 2006 and this prevalence was maintained in 2015/2016. In rural areas, awareness concerning hypertension rose from 44.8% in 2006 to 67.3% in 2015/2016, and control from 5.3% to 27.1%, so that awareness and control were similar in urban and rural areas in 2015/2016. After an adjustment for potential confounding factors, the likelihood of having hypertension more than doubled among men (OR = 2.03; p < 0.001), middle (OR = 4.41; p < 0.001) and old-age subjects (OR = 14.44; p < 0.001), and those who had abdominal obesity (OR = 2.04; p < 0.001) in urban areas and among middle-aged (OR = 2.56; p < 0.001), less educated individuals (OR = 2.21; p = 0.006) and those who were overweight (OR = 2.23; p < 0.001) in rural areas. Despite the favorable evolution in the management of hypertension in Pernambuco, public health measures focused in vulnerable populations are still required, mainly in rural areas, to improve primary prevention and decrease the disease rate.
Highlights
The social, human and economic impacts of noncommunicable diseases, especially cardiovascular disorders [1,2,3], led the United Nations to invite heads of state to debate the issue in 2011. This highlevel meeting resulted in a global action plan to prevent and control these diseases, including global goals and monitoring indicators to cut by 25% premature mortality related to cardiovascular diseases by 2025 4, highlighting the reduction and prevention of raised blood pressure
Data from May Measurement Month 2017 showed that hypertension prevalence was 34.9% in the world 7 and the Brazilian National Health Survey determined a prevalence of 22.8% for raised blood pressure 8
Awareness, treatment and control of high blood pressure are markedly higher in urban areas [9,10]
Summary
The social, human and economic impacts of noncommunicable diseases, especially cardiovascular disorders [1,2,3], led the United Nations to invite heads of state to debate the issue in 2011. This highlevel meeting resulted in a global action plan to prevent and control these diseases, including global goals and monitoring indicators to cut by 25% premature mortality related to cardiovascular diseases by 2025 4, highlighting the reduction and prevention of raised blood pressure. Pernambuco, the second most populous state in the Northeast region of Brazil, had a 0.54 Human Development Index (HDI) in 2000 and 0.67 in 2010, always below national average 12. The country improvements were disproportionate, maintaining the same vulnerable groups and areas 14
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