Self-reported hypertension in adults residing in Campinas, Brazil: prevalence, associated factors and control practices in a population-based study

Zangirolani, Lia Thieme Oikawa; Assumpção, Daniela de; Medeiros, Maria Angélica Tavares de; Barros, Marilisa Berti Azevedo

doi:10.1590/1413-81232018234.16442016

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Free Themes • Ciênc. saúde colet. 23 (4) • Apr 2018 • https://doi.org/10.1590/1413-81232018234.16442016 copy

Self-reported hypertension in adults residing in Campinas, Brazil: prevalence, associated factors and control practices in a population-based study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

Evaluate the prevalence of self-reported hypertension in adults aged 20 to 59 years as well as identify associated factors, the use of health services and disease control practices according to the possession or not of a private healthcare plan.

Methods:

A population-based, cross-sectional study was conducted in the city of Campinas, Brazil, involving 957 adults.

Results:

The prevalence of self-reported hypertension was 14.1%, with greater frequencies found among women, individuals aged ≥ 40 years, those who declared their skin color to be black, those with less schooling, those who did not practice active leisure activities, ex-smokers, overweight or obese individuals and those who rated their own health as not being excellent/very good. No inequalities were detected between individuals with hypertension covered by a private healthcare plan or the Brazilian public healthcare system with regard to access to services, the use of disease-controlling medications and having received counseling on how to manage the disease. However, differences were found regarding the practice of physical activity and diet.

Conclusion:

Despite the equity disclosed in access to health care, the present findings demonstrate that an insufficient proportion of adults adopt changes in lifestyle to control hypertension, underscoring the central role of public health administrators.

Key words
Hypertension; Adult health; Epidemiological surveys; Population groups

Variables and categories		n	% (95% CI)	PR (95% CI)
Sex			p = 0.0138 ^* * p-value of chi-squared test.
	Male	449	11.5 (9.3-14.2)	1
	Female	508	16.5 (13.8-19.7)	1.43 (1.08-1.90)
	Total	957	14.1 (12.3-16.1)
Age group (in years)			p = 0.0000 ^* * p-value of chi-squared test.
	20 to 29	305	3.3 (1.6-6.5)	1
	30 to 39	232	7.4 (4.4-12.0)	2.25 (1.01-4.98)
	40 to 49	224	21.1 (16.6-26.5)	6.45 (3.03-13.75)
	50 to 59	196	31.9 (26.2-38.1)	9.74 (4.71-20.13)
Ethnicity/skin color			p = 0.0421 ^* * p-value of chi-squared test.
	White	697	12.8 (10.8-15.0)	1
	Black	85	21.4 (13.9-31.5)	1.68 (1.08-2.60)
	Brown	168	15.9 (11.8-21.1)	1.25 (0.90-1.73)
Conjugal status			p = 0.0000 ^* * p-value of chi-squared test.
	Married/stable union	594	15.5 (13.1-18.2)	1
	Separated/widowed	105	27.9 (21.8-35.0)	1.80 (1.30-2.50)
	Single	258	5.5 (3.2-9.4)	0.36 (0.20-0.63)
Number of children			p = 0.0000 ^* * p-value of chi-squared test.
	0	297	4.8 (2.9-8.0)	1
	1 to 2	450	14.1 (11.7-16.9)	2.91 (1.71-4.95)
	3 or more	210	28.1 (22.9-33.9)	5.80 (3.38-9.93)
Schooling (in years)			p = 0.0000 ^* * p-value of chi-squared test.
	0 to 7	273	24.5 (19.4-30.5)	2.59 (1.68-4.01)
	8 to 11	400	10.7 (8.0-14.1)	1.13 (0.70-1.82)
	12 or more	284	9.4 (6.6-13.3)	1
Household income			p = 0.3782^* * p-value of chi-squared test.
	< 1 Brazilian monthly minimum wage (BMMW)	382	15.0 (12.1-18.4)	1
	≥ 1 to ≤ 3 times BMMW	395	12.4 (9.4-16.2)	0.83 (0.58-1.18)
	> 3 times BMMW	180	15.9 (11.9-21.0)	1.06 (0.75-1.51)
Private health insurance plan			p = 0.7659^* * p-value of chi-squared test.
	Yes	412	13.8 (11.2-16.8)	1
	No	545	14.4 (11.9-17.2)	1.04 (0.79-1.37)
Number of appliances in home			p = 0.2984^* * p-value of chi-squared test.
	1 to 5	110	18.7 (13.4-25.4)	1.38 (0.94-2.04)
	6 to 10	287	13.7 (10.0-18.3)	1.01 (0.70-1.45)
	11 or more	558	13.5 (11.2-16.2)	1

Variables and categories		n	% (95% CI)	PR (95% CI)
Leisure			p = 0.0007 ^* * p-value of chi-squared test.
	Inactive	644	17.2 (14.8-19.8)	1.98 (1.17-3.33)
	Insufficiently active	134	7.1 (4.0-12.3)	0.82 (0.37-1.80)
	Active	179	8.7 (5.1-14.2)	1
Tobacco			p = 0.0032 ^* * p-value of chi-squared test.
	Non-smoker	648	12.7 (10.4-15.5)	1
	Ex-smoker	110	26.4 (19.0-35.4)	2.07 (1.41-3.03)
	Smoker	197	11.9 (7.6-18.2)	0.93 (0.55-1.58)
Frequency of alcohol intake			p = 0.0089 ^* * p-value of chi-squared test.
	Never	501	16.7 (13.5-20.3)	1
	1 to 4 times per month	329	8.8 (6.0-12.7)	0.53 (0.33-0.83)
	2 or more times per week	125	18.4 (12.3-26.6)	1.10 (0.68-1.77)
Alcohol dependency			p = 0.4465^* * p-value of chi-squared test.
	Negative	868	13.8 (11.8-16.1)	1
	Positive	88	16.7 (10.6-25.2)	1.21 (0.74-1.96)
BMI (kg/m²)			p = 0.0000 ^* * p-value of chi-squared test.
	Underweight	37	7.6 (2.6-19.8)	1.05 (0.36-3.01)
	Ideal range	455	7.2 (5.4-9.6)	1
	Overweight	301	15.2 (12.1-18.9)	2.10 (1.43-3.09)
	Obesity	144	36.8 (30.8-43.2)	5.08 (3.61-7.16)

Variables and categories		n	% (95% CI)	PR (95% CI)
Number of health complaints			p = 0.0000 ^* * p-value of chi-squared test.
	0	287	8.5 (5.7-12.4)	1
	1 to 2	456	13.2 (10.8-16.1)	1.55 (0.99-2.44)
	3 or more	214	23.9 (18.9-29.7)	2.81 (1.80-4.38)
Number of chronic diseases			p = 0.0000 ^* * p-value of chi-squared test.
	0	654	8.8 (7.1-10.9)	1
	1	208	18.1 (13.1-24.5)	2.05 (1.36-3.11)
	2 or more	85	42.1 (31.5-53.5)	4.78 (3.35-6.83)
Self-rated health			p = 0.0000 ^* * p-value of chi-squared test.
	Excellent/very good	399	5.9 (4.2-8.2)	1
	Good	493	18.5 (15.7-21.8)	3.15 (2.14-4.64)
	Poor/very poor	65	33.0 (20.6-48.2)	5.60 (3.17-9.88)

Variables and categories		First step PR _adjusted^* * Prevalence ratio adjusted for demographic and socioeconomic variables. (95% CI)	Second step PR _adjusted^ Adjusted for demographic variables, socioeconomic variables, health-related behaviors and body mass index. (95% CI)	Third step PR _adjusted^* ***** Adjusted for all variables in table. (95% CI)
Sex
	Male	1	1	1
	Female	1.37 (1.03-1.82)	1.31 (0.99-1.72)	1.14 (0.85-1.53)
Age group (in years)
	20 to 29	1	1	1
	30 to 39	2.08 (0.93-4.63)	1.61 (0.74-3.50)	1.56 (0.72-3.34)
	40 to 49	6.03 (2.76-13.13)	4.55 (2.16-9.62)	4.05 (1.87-8.76)
	50 to 59	8.65 (4.04-18.53)	5.90 (2.73-12.70)	4.65 (2.12-10.18)
Ethnicity/skin color
	White	1	1	1
	Black	1.87 (1.27-2.74)	1.58 (1.15-2.19)	1.48 (1.00-2.18)
	Brown	1.29 (0.93-1.79)	1.21 (0.87-1.68)	1.16 (0.84-1.61)
Schooling (in years)
	0 to 7	1.65 (1.05-2.60)	1.49 (0.98-2.26)	1.18 (0.80-1.74)
	8 to 11	1.23 (0.75-2.00)	1.19 (0.75-1.88)	0.97 (0.63-1.51)
	12 or more	1	1	1
Leisure
	Inactive		1.75 (1.09-2.81)	1.56 (0.98-2.48)
	Insufficiently active		1.05 (0.55-2.00)	0.97 (0.51-1.87)
	Active		1	1
Tobacco
	Non-smoker		1	1
	Ex-smoker		1.40 (1.03-1.89)	1.18 (0.85-1.64)
	Smoker		0.91 (0.57-1.45)	0.84 (0.53-1.33)
Body mass index (Kg/m²)
	Underweight		0.89 (0.35-2.28)	0.87 (0.34-2.24)
	Ideal range		1	1
	Overweight		1.50 (1.07-2.10)	1.39 (0.96-2.02)
	Obesity		3.04 (2.19-4.23)	2.56 (1.80-3.63)
Number of chronic diseases
	0			1
	1			1.31 (0.90-1.91)
	2 or more			1.71 (1.18-2.47)
Self-rated health
	Excellent/very good			1
	Boa			1.95 (1.26-3.01)
	Poor/very poor			1.93 (1.06-3.50)

Variables and categories		Total		Private health insurance				p value^* * p-value of chi-squared test.
		Total		Yes		No
		n	%	n	%	n	%
Time elapsed since diagnosis of hypertension (in years)								0.4863
	0 to 5	83	59.8	33	57.0	50	61.9
	6 or more	56	40.2	25	43.0	31	38.1
	Total	139		58		81
Visit to physician/health service for hypertension follow up								0.2620
	No	34	24.7	11	19.2	23	28.7
	Yes	105	75.3	47	80.8	58	71.3
Reason for not regularly visiting physician/health service								0.3040
	Does not think it necessary	21	63.4	8	73.2	13	58.4
	Lack of time	4	11.2	1	8.6	3	12.5
	Difficulty regarding geographic access	2	5.5	0	0.0	2	8.3
	Others	7	20.0	3	26.8	4	16.6
	Total	34		11		23
Last visit to physician/health service for hypertension follow up								0.8848
	In previous month	27	19.5	10	17.7	17	20.9
	One year ago	89	64.3	38	65.0	51	63.7
	More than one year ago	22	16.2	10	17.3	12	15.3
Participation in hypertension groups								0.3739
	No	134	96.5	57	98.2	77	95.3
	Yes	5	3.5	1	1.7	4	4.7
Received counseling from physician/health service regarding hypertension								0.6275
	No	39	28.8	15	26.6	24	30.5
	Yes	99	71.2	42	73.4	57	69.5
Hypertension control measures
	Diet without salt	31	22.2	13	23.1	18	21.6	0.8209
	Dieting to lose/maintain weight	12	9.0	9	16.1	3	3.6	0.0063
	Physical activity	14	10.2	10	17.4	4	4.8	0.0115
	Routine medication	103	73.9	42	72.6	61	74.9	0.7308
	Medication when problem arises	14	10.0	7	11.9	7	8.6	0.5110
	Nothing	16	11.6	4	6.8	12	15.3	0.1161

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[1] Collaborations

LTO Zangirolani and D Assumpção participated in the design, analysis and writing of the article; MAT Medeiros of the final review of the article; MBA Barros of research coordination, analysis and final article review.