Hypertension bearers with high risk/big risk of cardiovascular diseases and socioeconomic and health indicators

Costa, Simone de Melo; Lima, Cássio de Almeida; Nobre, André Luiz Cândido Sarmento Drumond; Vieira, Davi de Melo Alvarenga; Leal, André Luiz Ramos

doi:10.1590/1806-9282.64.07.601

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Brasil

Revista da Associação Médica Brasileira

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Original Article • Rev. Assoc. Med. Bras. 64 (7) • July 2018 • https://doi.org/10.1590/1806-9282.64.07.601 copy

Hypertension bearers with high risk/big risk of cardiovascular diseases and socioeconomic and health indicators

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE

To correlate the number of hypertensive patients with high and very high risk for cardiovascular diseases with socioeconomic and health indicators.

METHODS

An ecological study carried out from the National Registry of Hypertension and Diabetes (SisHiperDia). The variable “hypertensive patients with high and very high risk” was correlated with the Human Development Index, health care costs and services, average household income per capita, per capita municipal income, number of hospital admissions in SUS, number of medical consultations in the SUS and specific mortality due to diseases of the circulatory system, considering the 27 federative units of Brazil. The data was processed in software IBM Statistical Package for the Social Sciences (SPSS) Statistics, version 22.00. The statistical analysis considered the level of significance p<0.05.

RESULTS

Brazilian states with more hypertensive registries in high/very high risk spend more on public health, fewer people reach the elderly age group and more deaths from diseases of the circulatory system (p<0.05). The very high risk stratum correlated with more physicians per population (p<0.05).

CONCLUSION:

Systemic arterial hypertension has a direct impact on life expectancy and also on the economic context, since when it evolves to high and very high risk for cardiovascular diseases, it generates more expenses in health and demand more professionals, burdening the public health system. Monitoring is necessary in order to consolidate public policies to promote the health of hypertensive individuals.

KEYWORDS:
Hypertension; Public health; Brazil; Economic indexes; Social indicators

Stratified risk and quantification of blood pressure prognosis (mmHg)
Risk factors or disease	Grade 1 Mild hypertension SBP ^* * SBP: systolic blood pressure. 140-159 or DBP ^ DBP: diastolic blood pressure. 90-99	Grade 2 Moderate hypertension SBP ^* * SBP: systolic blood pressure. 160-179 or DBP ^ DBP: diastolic blood pressure. 100-109	Grade 3 Severe hypertension SBP ^* * SBP: systolic blood pressure. ≥180 or DBP ^ DBP: diastolic blood pressure. ≥110
I- No other risk factors.	Low risk	Average risk	High risk
II- One to two risk factors.	Average risk	Average risk	Very high risk
III- Three or more risk factors, or lesions in the target organs, or diabetes mellitus.	High risk	High risk	Very high risk
IV - Associated clinical conditions, including cardiovascular or renal disease.	Very high risk	Very high risk	Very high risk

Region	UF	State total population	Number of hypertensive registries in the system	High risk (%)	Very high risk (%)	Total high/ very high risk (%)
North	RO	1,562,409	115,180	14.95	17.20	32.15
	AC	733,559	43,224	15.55	18.77	34.32
	AM	3,483,985	282,282	15.84	4.91	20.75
	RR	450,479	20,383	17.29	15.30	32.59
	PA	7,581,051	256,888	17.55	16.25	33.80
	AP	669,526	18,218	20.29	16.28	36.57
	TO	1,383,445	99,163	13.74	14.85	28.59
Northeast	MA	6,574,789	325,570	16.17	12.95	29.12
	PI	3,118,360	217,443	15.33	11.06	26.39
	CE	8,452,381	342,828	16.76	9.24	26.00
	RN	3,168,027	154.808	18.61	12.85	31.46
	PB	3,766,528	323,639	19.41	14.38	33.79
	PE	8,796,448	400,846	18.51	12.53	31.04
	AL	3,120,494	139,660	19.51	11.52	31.03
	SE	2,068,017	104,283	20.46	12.36	21.82
	BA	14,016,906	932,831	18.15	12.01	30.16
Southeast	MG	19,597,330	1.395,732	15.46	14.99	30.45
	ES	3,514,952	297,709	17.86	15.17	33.03
	RJ	15,989,929	646,829	20.36	16.10	36.46
	SP	41,262,199	1,719,462	20.65	13.13	33.78
South	PR	10,444,526	723,455	15.48	17.46	32.94
	SC	6,248,436	412,357	17.01	17.86	34.87
	RS	10,693,929	598,461	18.78	18.16	36.94
Mid-West	MT	3,035,122	240,928	14.65	16.78	31.43
	MS	2,449,024	148,405	15.44	15.80	31.24
	GO	6,003,788	290,373	14.72	18.26	32.98
	DF	2,570,160	50,493	22.12	15.49	37.61

Risk for cardiovascular diseases	Brazilian region	Average	Median	p^* * Kruskal-Wallis Test.
High	North	29,997.57	25,897.17	0.002
	Northeast	98,502.02	93,417.06
	Southeast	239,398.21	243,308.37
	South	145,846.65	143,939.10
	Mid-West	43,382.76	50,275.47
Very high	North	20,815.53	14,342.09	0.003
	Northeast	61,357.20	56,005.12
	Southeast	197,992.15	181,698.33
	South	101,462.00	115,454.48
	Mid-West	29,427.12	30,317.53

	r	r²	p
HDI	0.158	0.024	0.432
HDI income	0.125	0.015	0.536
HDI education	0.196	0.038	0.328
Survival at 60 years old	-0.475	0.225	0.012^* * Significant at the level of 5%.
Expenditures with public health per capita	0.926	0.857	<0.001^* * Significant at the level of 5%.
Average household income per capita	0.131	0.017	0.516
SUS Admission	-0.088	0.007	0.663
Number of consultations in public health per inhabitant	0.209	0.043	0.296
Number of medical professionals per inhabitant	0.375	0.141	0.054
Mortality rate per coronary artery disease - CAD	0.952	0.906	<0.001^* * Significant at the level of 5%.

	r	r²	p
HDI	0.209	0.044	0.296
HDI income	0.181	0.033	0.365
HDI education	0.230	0.053	0.248
Survival at 60 years old	-0.415	0.172	0.032^* * Significant at the level of 5%.
Expenditures with public health per capita	0.951	0.904	<0.001^* * Significant at the level of 5%.
Average household income per capita	0.186	0.035	0.354
SUS Admission	-0.159	0.025	0.429
Number of consultations in public health per inhabitant	0.153	0.023	0.445
Number of medical professionals per inhabitant	0.423	0.179	0.028^* * Significant at the level of 5%.
Mortality rate per coronary artery disease - CAD	0.951	0.904	<0.001^* * Significant at the level of 5%.

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[1] CORRESPONDING AUTHOR: Cássio de Almeida Lima, Universidade Federal dos Vales do Jequitinhonha e Mucuri. Rodovia MGT 367 - Km 583, nº 5000, Alto da Jacuba - CEP 39100-000 - Diamantina, MG - Brasil Tel: (38) 9 9246 0 602 E-mail: cassioenf2014@gmail.com