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Original Articles • Rev. Saúde Pública 50 (suppl 2) • 12 Dec 2016 • https://doi.org/10.1590/S1518-8787.2016050006154 copy

Access to and use of high blood pressure medications in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To analyze the access to and use of medicines for high blood pressure among the Brazilian population according to social and demographic conditions.

METHODS

Analysis of data from Pesquisa Nacional Sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), a nationwide cross-sectional, population-based study, with probability sampling, carried out between September 2013 and February 2014 in urban households in the five Brazilian regions. The study evaluated the access and use of medicines to treat people with high blood pressure. The independent variables were gender, age, socioeconomic status and Brazilian region. The study also described the most commonly used drugs and the percentage of people treated with one, two, three or more drugs. Point estimations and confidence intervals were calculated considering the sample weights and sample complex plan.

RESULTS

Prevalence of high blood pressure was 23.7% (95%CI 22.8–24.6). Regarding people with this condition, 93.8% (95%CI 92.8–94.8) had indication for drug therapy and, of those, 94.6% (95%CI 93.5–95.5) were using the medication at the time of interview. Full access to medicines was 97.9% (95%CI 97.3–98.4); partial access, 1.9% (95%CI 1.4–2.4); and no access, 0.2% (95%CI 0.1–0.4). The medication used to treat high blood pressure, 56.0% (95%CI 52.6–59.2) were obtained from SUS (Brazilian Unified Health System), 16.0% (95%CI 14.3–17.9) from Popular Pharmacy Program, 25.7% (95%CI 23.4–28.2) were paid for by the patients themselves and 2.3% (95%CI 1.8–2.9) were obtained from other locations. The five most commonly used drugs were, in descending order, hydrochlorothiazide, losartan, captopril, enalapril and atenolol. Of the total number of patients on treatment, 36.1% (95%CI 34.1–37.1) were using two medicines and 13.5% (95%CI 12.3–14.9) used three or more.

CONCLUSIONS

Access to medicines for the treatment of high blood pressure may be considered high and many of them are available free of charge. The most commonly used drugs are among those recommended as first-line treatment for high blood pressure control. The percentage of people using more than one drug seems to follow the behavior observed in other countries.

Antihypertensive Agents, supply & distribution; Drug Utilization; Drugs of Continuous Use; Health Services Accessibility; Socioeconomic Factors; Health Surveys

Variable		Prevalence of hypertension			Hypertension patients with indication for drug treatment			Hypertension patients with indication for drug treatment using medication		p

		%	95%CI	p	%	95%CI	p	%	95%CI
Gender	Male	18.5	17.4–19.8		93.1	91.2–94.6		93.4	91.5–94.9
Gender	Female	28.1	27.0–29.1	< 0.001	94.1	92.9–95.1	0.292	95.2	94.2–96.1	0.026
Age group	20 to 39	6.0	5.2–6.9		78.0	71.1–83.6		78.4	70.8–84.5
	40 to 59	27.5	26.3–28.8		93.4	91.9–94.7		94.7	93.4–95.8
	60 or over	59.0	57.4–60.5	< 0.001	98.1	97.6–98.5	< 0.001	97.6	97.0–98.1	< 0.001
Brazilian region	North	16.3	14.6–18.1		91.7	89.0–93.9		91.4	88.1–93.8
	Northeast	21.7	20.3–23.1		92.2	90.0–93.9		91.1	87.6–93.7
	Southeast	26.0	24.3–27.7		94.9	93.0–96.2		95.6	94.2–96.7
	South	22.4	20.8–24.0		93.0	90.4–95.0		97.4	96.1–98.2
	Midwest	24.1	22.0–26.3	< 0.001	92.9	90.4–94.8	0.495	94.0	92.2–95.5	< 0.001
CCEB^b	A/B	22.3	20.4–24.3		94.7	92.6–96.2		96.2	94.3–97.5
	C	23.9	22.8–25.0		93.4	91.9–94.7		94.8	93.6–95.8
	D/E	24.7	23.1–26.3	0.127	93.5	91.5–95.1	0.064	92.3	89.2–94.6	0.019

Total		23.7	22.8–24.6		93.7	92.6–94.7		94.6	93.5–95.5

Variable		Full access^b		Partial access^c		No access^d		p

		%	95CI%	%	95CI%	%	95CI%
Gender	Male	98.6	97.8–99.0	1.3	0.9–2.0	0.1	0.0–0.3
Gender	Female	97.6	96.8–98.2	2.2	1.6–3.0	0.3	0.1–0.5	0.046
Age group	20 to 59	97.2	96.1–97.9	2.5	1.7–3.5	0.4	0.2–0.7
Age group	60 or over	98.6	98.0–99.1	1.3	0.9–1.9	0.05	0.0–0.1	0.001
Brazilian region	North	97.1	93.6–98.7	2.5	1.0–6.2	0.3	0.2–0.7
	Northeast	96.1	94.4–97.2	3.3	2.2–4.9	0.6	0.3–1.4
	Southeast	98.7	97.7–99.2	1.3	0.7–2.2	0.1	0.0–0.4
	South	99.2	98.3–99.6	0.7	0.3–1.6	0.1	0.0–0.5
	Midwest	95.7	93.8–97.0	4.0	2.7–5.8	0.4	0.1–1.1	< 0.001
CCEB^e	A/B	98.6	97.6–99.2	1.0	0.5–2.0	0.4	0.1–1.2
	C	97.7	96.8–98.3	2.2	1.6–3.0	0.1	0.1–0.3
	D/E	97.7	96.6–98.5	2.0	1.3–3.2	0.3	0.1–0.6	0.103

Total		97.9	97.3–98.4	1.9	1.4–2.4	0.2	0.1–0.4

Drug	%	95CI%	cumulative %
Hydrochlorothiazide	23.9	22.7–25.1	23.9
Losartan	20.1	19.0–21.3	44.0
Captopril	11.2	10.2–12.2	55.2
Enalapril	10.5	9.4–11.7	65.7
Atenolol	9.0	8.2–9.9	74.6
Amlodipine	6.0	5.4–6.6	80.6
Propranolol	4.1	3.6–4.7	84.7
Furosemide	2.4	2.0–2.8	87.1
Nifedipine	1.8	1.5–2.2	88.9
Chlorthalidone	1.8	1.4–2.2	90.7
Other hypertension drugs	9.3	8.4–10.3	100

Variable		One drug	95CI%	Two drugs	95CI%	Three or more drugs	95CI%	p
Gender	Male	52.4	46.9–55.2	35.5	32.9–38.2	12.0	10.3–14.0	0.034
Gender	Female	48.5	46.6–50.5	37.2	35.4–39.0	14.3	12.9–15.9	0.034
Age group	20 to 39	56.7	49.0–64.1	33.1	25.6–41.5	10.2	5.9–17.0	0.061
	40 to 59	51.1	48.2–49.8	36.9	34.1–39.8	12.0	10.3–13.8
	60 or over	47.8	45.9–49.8	36.9	35.1–38.7	15.3	13.7–17.0
Number of chronic diseases	HBP only	54.0	51.3–56.6	36.3	34.0–38.6	9.8	8.0–11.9	0.001
	HBP and another chronic disease	51.8	48.8–54.9	35.4	32.5–38.4	12.8	10.9–14.9
	HBP and two or more other chronic diseases	44.1	41.5–46.9	37.8	35.5–40.3	18.0	15.9–20.2
Brazilian region	North	71.9	68.6–75.0	24.7	22.0–27.6	3.4	2.6–4.6	0.001
	Northeast	48.7	45.7–51.6	38.6	35.6–41.5	12.7	10.8–14.8
	Southeast	48.5	46.0–51.1	36.9	34.6–39.3	14.6	12.6–16.9
	South	51.7	48.0–55.3	35.8	32.9–38.8	12.5	10.7–14.5
	Midwest	47.5	43.7–51.3	37.1	33.9–40.4	15.5	13.1–18.1

Total		49.9	48.3–51.5	36.1	34.1–37.1	13.5	12.3–14.9

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