Trends in the prevalence of systemic arterial hypertension and health care service use in Brazil over a decade (2008-2019)

Julião, Nayara Abreu; Souza, Aline de; Guimarães, Raquel Rangel de Meireles

doi:10.1590/1413-81232021269.08092021

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ARTICLE • Ciênc. saúde coletiva 26 (09) • Sept 2021 • https://doi.org/10.1590/1413-81232021269.08092021 copy

Trends in the prevalence of systemic arterial hypertension and health care service use in Brazil over a decade (2008-2019)

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The global burden and the prevalence of systemic arterial hypertension (SAH) have increased over the last two decades, especially in low- and middle-income countries, and are a concern to health authorities. This study analyzed the prevalence of SAH reported by Brazilian adults in 2008, 2013, and 2019, and individual disease control in 2013 and 2019. Data from the National Household Sample Survey (2008) and National Health Survey (2013-2019) were employed. We calculated the disease’s prevalence ratios using Poisson regression, adjusted for sociodemographic characteristics. Regarding health care and PHC organization indicators, we calculated proportions by gender, age group, ethnicity, and region. The results reveal persistent regional inequalities, with lower prevalence in the North and Northeast and higher prevalence in the Southeast and South. While the health care access and use indicators are positive, reflecting PHC improvements in recent years, we highlight the importance of adopting multifaceted SAH prevention and control strategies in the country.

Key words:
Systemic arterial hypertension; Prevalence; Health Care service use; Primary health care

Variables	2008		2013		2019
Variables	%	PR (CI95)	%	PR (CI95)	%	PR (CI95)
Never had BP measured	-		3.0		2.0
Reported hypertension	19.9		21.4		23.9
Gender
Male	16.4	1	18.1	1	21.1	1
Female	23.0	1.3 (1.3-1.3)	24.3	1.3 (1.2-1.3)	26.4	1.2 (1.1-1.2)
Ethnicity
White	20.2	1	22.1	1	24.4	1
Black	24.7	1.3 (1.2-1.3)	24.2	1.1 (1.0-1.2)	25.8	1.2 (1.1-1.2)
Brown	18.6	1.0 (1.0-1.1)	20.0	1.0 (1.0-1.1)	22.9	1.1 (1.0-1.1)
Age group
18-29	2.9	1	2.9	1	2.8	1
30-59	19.5	6.3 (6.0-6.6)	20.5	6.5 (5.6-7.5)	20.3	6.5 (5.6-7.6)
60-64	48.4	14.3 (13.5-15.0)	44.2	12.9 (11.0-15.2)	46.9	13.8 (11.8-16.3)
65-74	54.4	15.7 (14.9-16.5)	53.0	15.0 (12.8-17.6)	56.6	16.3 (14.0-19.1)
75 and over	57.1	16.0 (15.2-16.8)	55.0	15.2 (12.9-17.8)	62.1	17.3 (14.8-20.3)
Schooling
No education and incomplete elementary school	28.7	1.5 (1.4-1.6)	31.1	1.4 (1.3-1.5)	36.6	1.5 (1.4-1.6)
Elementary school and incomplete high school	14.2	1.2 (1.2-1.3)	16.7	1.2 (1.1-1.4)	20.4	1.3 (1.2-1.5)
High school and incomplete higher education	10.6	1.0 (1.0-1.0)	13.4	1.0 (0.9-1.1)	15.4	1.1 (1.0-1.2)
Higher education	15.4	1	17.9	1	18.2	1
Area of residence
Rural	18.9	1	19.8	1	23.2	1
Urban	20.1	1.1 (1.1-1.2)	21.6	1.1 (1.1-1.2)	24.0	1.1 (1.1-1.2)
Region
North	14.1	1	14.4	1	16.8	1
Northeast	18.2	1.1 (1.1-1.2)	19.5	1.2 (1.1-1.3)	23.1	1.2 (1.2-1.3)
Southeast	21.7	1.3 (1.2-1.4)	23.3	1.3 (1.2-1.5)	25.9	1.4 (1.3-1.5)
South	21.0	1.3 (1.2-1.4)	22.8	1.4 (1.3-1.5)	24.5	1.3 (1.2-1.4)
Midwest	18.6	1.2 (1.2-1.3)	21.1	1.3 (1.2-1.4)	21.9	1.3 (1.2-1.3)
N	271.667	267.965	60.202	57.498	88.531	85.553

Variables	2013			2019
Variables	Total (%)	Men (%)	Women (%)	Total (%)	Men (%)	Women (%)
Took hypertension medications in the past two weeks	81.6	77.1	84.6	88.0	84.2	90.7
Received care for hypertension in the last 12 months	69.7	65.6	72.5	72.2	68.9	74.5
Treatment place
PHC Unit	46.0	40.9	49.2	45.8	41.8	48.5
Private clinic	24.5	27.7	22.5	28.8	32.3	26.5
SUS service	65.6	61.0	68.5	65.6	61.3	68.5
Last visit with the same doctor from the previous visits	56.5	54.9	57.4	51.9	52.3	51.7
Took all the requested tests	91.9	92.2	91.8	89.6	90.5	89.0
Agreement of care plan with health professionals	96.5	96.7	96.4	95.1	95.2	95.0
Did all the visits or was referred and visited specialists	87.3	86.9	87.6	90.4	90.5	90.2
Has sometimes been hospitalized because of hypertension or complications	14.0	12.5	14.9	12.7	11.2	13.7
Usual activities are limited due to hypertension, either intensely or very intensely	4.7	4.2	5.0	3.0	3.1	3.0

Variables	2013				2019
Variables	Total (%)	White (%)	Black (%)	Brown (%)	Total (%)	White (%)	Black (%)	Brown (%)
Took hypertension medications in the past two weeks	81.6	84.7	79.6	78.5	88.0	89.4	88.0	86.5
Received care for hypertension in the last 12 months	69.7	70.1	70.4	69.4	72.2	71.5	74.7	72.1
Treatment place
PHC Unit	46.0	41.4	50.0	50.9	45.8	39.4	51.9	50.7
Private clinic	24.5	31.8	16.4	17.3	28.8	38.6	20.0	21.3
SUS service	65.6	57.0	77.8	73.4	65.6	55.3	74.6	73.6
Last visit with the same doctor from the previous visits	56.5	62.3	50.8	50.5	51.9	56.7	48.8	48.2
Took all the requested tests	91.9	94.1	85.9	90.7	89.6	91.6	87.0	88.0
Agreement of care plan with health professionals	96.5	96.7	96.6	96.3	95.1	95.4	95.2	94.6
Did all the visits or was referred and visited specialists	87.3	90.8	80.9	84.6	90.4	92.8	87.9	88.3
Has sometimes been hospitalized because of hypertension or complications	14.0	13.3	15.2	14.5	12.7	11.0	13.6	14.2
Usual activities are limited due to hypertension, either intensely or very intensely	4.7	4.4	4.0	5.2	3.0	2.2	3.5	3.6

Variables	2013						2019
Variables	Total (%)	18-29 (%)	30-59 (%)	60-64 (%)	65-74 (%)	75 and over (%)	Total (%)	18-29 (%)	30-59 (%)	60-64 (%)	65-74 (%)	75 and over (%)
Took hypertension medications in the past two weeks	81.6	35.4	77.2	88.7	91.5	92.3	88.0	40.3	83.2	93.2	95.2	96.7
Received care for hypertension in the last 12 months	69.7	60.6	68.3	72.1	73.0	71.1	72.2	62.9	71.1	74.3	73.6	73.1
Treatment place
PHC Unit	46.0	36.1	46.8	45.6	47.4	43.0	45.8	47.1	45.5	48.2	47.8	41.3
Private clinic	24.5	17.5	23.9	25.5	24.2	29.3	28.8	17.6	28.0	28.3	29.0	33.6
SUS service	65.6	67.0	66.2	65.7	66.4	61.1	65.6	77.7	66.1	67.3	66.0	59.7
Last visit with the same doctor from the previous visits	56.5	39.8	55.0	55.2	60.1	63.0	51.9	37.6	49.6	53.4	55.1	56.1
Took all the requested tests	91.9	88.5	89.9	91.7	95.2	96.3	89.6	86.9	88.0	91.2	90.2	92.6
Agreement of care plan with health professionals	96.5	94.1	96.7	97.7	96.9	94.7	95.1	93.4	95.3	95.7	95.2	94.0
Did all the visits or was referred and visited specialists	87.3	67.0	84.6	92.8	93.0	89.8	90.4	77.9	88.4	92.0	92.6	93.3
Has sometimes been hospitalized because of hypertension or complications	14.0	6.9	12.6	15.3	15.9	17.9	12.7	10.7	11.9	14.1	12.4	14.6
Usual activities are limited due to hypertension, either intensely or very intensely	4.7	2.1	4.7	4.2	4.2	6.4	3.0	2.9	3.1	2.9	2.6	3.3

Variáveis	2013						2018
Variáveis	Total (%)	North	Northeast	Southeast	South	Midwest	Total (%)	North	Northeast	Southeast	South	Midwest
Took hypertension medications in the past two weeks	81.6	72.0	78.4	83.8	83.8	79.8	88.0	81.9	87.5	88.8	89.6	86.2
Received care for hypertension in the last 12 months	69.7	71.9	67.9	71.6	68.4	64.9	72.2	74.7	71.9	73.0	70.8	68.5
Treatment place
PHC Unit	46.0	49.8	45.2	45.0	48.6	46.8	45.8	50.6	48.4	41.5	53.2	46.1
Private clinic	24.5	17.9	18.8	27.7	25.1	25.9	28.8	20.9	21.2	34.0	28.2	29.4
SUS service	65.6	70.5	73.7	61.5	64.9	64.4	65.6	72.2	74.2	60.1	66.5	64.0
Last visit with the same doctor from the previous visits	56.5	44.2	46.7	61.5	59.8	56.2	51.9	42.6	47.2	54.9	55.9	48.1
Took all the requested tests	91.9	88.7	87.1	93.7	93.9	92.5	89.6	87.8	86.9	90.0	92.6	91.3
Agreement of care plan with health professionals	96.5	95.6	96.1	96.7	96.9	96.6	95.1	96.2	95.3	94.9	94.7	95.3
Did all the visits or was referred and visited specialists	87.3	88.2	81.6	88.3	91.9	86.6	90.4	86.4	87.4	91.8	90.3	91.2
Has sometimes been hospitalized because of hypertension or complications	14.0	14.9	16.1	12.7	14.5	13.3	12.7	14.4	13.8	11.5	12.8	15.0
Usual activities are limited due to hypertension, either intensely or very intensely	4.7	5.0	5.5	4.1	5.0	4.6	3.0	4.1	3.6	2.6	3.2	2.8
% of residents in households registered with the ESF	56.1	53.4	68.1	48.2	58.5	54.5	62.6	62.2	73.3	54.6	67.6	60.1

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[1] Collaborations

All authors participated equally in the conception and design of the research, statistical analysis and interpretation of data, writing of the manuscript, critical review of the manuscript regarding important intellectual content until approval of the final version.