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

Santiago, Emerson Rogério Costa; Diniz, Alcides da Silva; Oliveira, Juliana Souza; Leal, Vanessa Sá; Andrade, Maria Izabel Siqueira de; Lira, Pedro Israel Cabral de

doi:10.5935/abc.20190145

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Original Article • Arq. Bras. Cardiol. 113 (4) • Oct 2019 • https://doi.org/10.5935/abc.20190145 copy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

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.

Keywords:
Hypertension/prevention and control; Prevalence; Cardiovascular Diseases; Epidemiology; Blood Pressure; Risk Factors

	Systemic arterial hypertension
Variables	n	%	95%CI	p-value^‡ ‡ Pearson’s chi-square test;
Gender				0.358
Male	44	30.1	22.8 – 38.3
Female	70	25.9	20.8 – 31.6
Age (years)				0.000^§ § chi-square test for trend.
20 – 29	13	10.6	05.7 – 17.4
30 – 39	20	15.9	10.0 – 23.4
40 – 49	25	36.8	25.4 – 49.3
50 – 59	56	56.6	46.2 – 66.5
Ethnicity				0.721
White	26	28.9	19.8 – 39.4
Multiracial or black	88	27.0	22.3 – 32.2
Schooling				0.000^§ § chi-square test for trend.
Never studied	66	44.6	36.4 – 53.0
Primary school	32	19.5	13.7 – 26.4
High school/university	16	15.4	09.1 – 23.8
Employment status				0.150
Works	45	23.9	18.0 – 30.7
Does not work	69	30.3	24.4 – 36.7
Place of residence
Urban area	65	27.0	21.5 – 33.0	0.816
Rural area	49	28.0	21.5 – 35.3
Economic class				0.001
Upper or middle^* * classes A1, A2, B1, B2, C1, and C2;	45	20.5	15.3 – 26.4
Lower^† † classes D and E;	69	35.2	28.5 – 42.3

Variables	Systemic arterial hypertension			p-value^§ § Pearson’s chi-square test.
Variables	n	%	95%CI	p-value^§ § Pearson’s chi-square test.
*Alcohol intake^ * considering the 30 days prior to data collection;**				0.330
Yes	26	31.7	21.9 – 42.9
No	88	26.3	21.8 – 31.5
Active smoking				0.000
Smoker or ex-smoker	54	55.7	45.2 – 65.8
Never smoked	60	18.8	14.8 – 23.6
Passive smoking^† † individuals who do not actively smoke but are frequently in contact with cigarette smoke from people at home, work, or school/university;				0.000
Yes	32	47.1	34.8 – 59.6
No	82	23.6	19.3 – 28.4
Physical activity level^‡ ‡ classified using the International Physical Activity Questionnaire (IPAQ);				0.078
Sedentary or insufficiently active	61	32.4	25.8 – 39.6
Active or very active	33	44.0	32.5 – 55.9
Addition of salt to food				0.200
Never	106	28.3	23.9 – 33.3
Sometimes or almost always	8	19.0	08.6 – 34.1

Variables	Systemic arterial hypertension			p-value^ Pearson’s chi-square test;
Variables	n	%	95%CI	p-value^ Pearson’s chi-square test;
BMI				0.019
Not overweight^* * BMI < 25.0 kg/m2;	29	19.9	13.7 – 27.3
Overweight^† † BMI ≥ 25.0 kg/m2;	76	30.6	25.0 – 36.8
WC				0.082
Normal^‡ ‡ < 80 cm for women and < 94 cm for men;	29	21.8	15.1 – 29.8
Increased^§ § ≥ 80 cm for women and ≥ 94 cm for men;	81	30.0	24.6 – 35.8
Waist-to-height ratio				0.012
Normal^// // < 0.52 for men and < 0.53 for women;	17	17.0	10.2 – 25.8
Increased^¶ ¶ ≥ 0.52 for men and ≥ 0.53 for women;	87	29.8	24.6 – 35.4
Food security^# # classified according to the Brazilian Food and Nutritional Insecurity Scale;				0.245^†† †† chi-square test for trend.
Food security	35	34.0	24.9 – 44.0
Mild food insecurity	33	23.7	16.9 – 31.7
Moderate or severe food insecurity	46	26.4	20.1 – 33.6

Variables	Systemic arterial hypertension			p-value^# # Pearson’s chi-square test.
Variables	n	%	95%CI	p-value^# # Pearson’s chi-square test.
Fasting blood glucose				0.000
Normal^* * < 100 mg/dL;	56	28.4	22.2 – 35.3
Reduced glucose tolerance and/or DM^† † ≥ 100 mg/dL or when hypoglycemic medication was used;	30	68.2	52.4 – 81.4
Triglycerides				0.416
Normal^‡ ‡ < 150 mg/dL;	32	32.7	23.5 – 42.9
High^§ § ≥ 150 mg/dL;	54	37.8	29.8 – 46.2
Total cholesterol				0.005
Normal^// // < 190 mg/dL;	27	25.7	17.7 – 35.2
High^¶ ¶ ≥ 190 mg/dL;	59	43.4	34.9 – 52.1

Variables	n	Systemic arterial hypertension				p-value^§ § Poisson regression with robust variance.
		Crude analysis		Adjusted analysis
		PR	95%CI	PR	95%CI
Age (years)
20 – 29	13	1.00		1.00
30 – 39	20	1.05	0.97 – 1.13	1.05	0.97 – 1.13	0.214
40 – 49	25	1.24	1.12 – 1.36	1.24	1.12 – 1.36	0.000
50 – 59	56	1.42	1.31 – 1.53	1.42	1.31 – 1.53	0.000
*Economic class^ * adjusted for age, schooling, and employment status;**
Upper or middle	45	1.00		1.00
Lower	69	1.12	1.05 – 1.20	1.09	1.02 – 1.17	0.007
Active smoking^† † adjusted for age, schooling, employment status, economic class, passive smoking, and physical activity level;
Never smoked	54	1.00		1.00
Smoker or ex-smoker	60	1.31	1.22 – 1.41	1.11	1.02 – 1.22	0.023
BMI^‡ ‡ adjusted for age, schooling, employment status, economic class, passive smoking, physical activity level, BMI, WC, waist-to-height ratio, and fasting blood glucose;
Not overweight	29	1.00		1.00
Overweight	76	1.09	1.02 – 1.17	1.21	1.07 – 1.37	0.003
Fasting blood glucose^‡ ‡ adjusted for age, schooling, employment status, economic class, passive smoking, physical activity level, BMI, WC, waist-to-height ratio, and fasting blood glucose;
Normal	56	1.00		1.00
Reduced glucose tolerance and/or DM	30	1.31	1.19 – 1.44	1.15	1.03 – 1.27	0.012

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[1] Mailing Address: Emerson Rogério Costa Santiago, Universidade Federal de Pernambuco - Programa de Pós-graduação em Nutrição - Av. Prof. Moraes Rêgo, 1235. Postal Code 50670-901, Recife, PE - Brazil. E-mail: emersoncostasantiago@gmail.com