Fatores associados à pressão arterial não controlada em brasileiros hipertensos

Abstract

Arterial hypertension (AH) is considered a multifactorial clinical condition characterized by elevated and sustained levels of blood pressure (BP). Considered one of the most important public health problems worldwide, it has a high prevalence and low rate of control. The control of AH is important, to avoid the appearance of specific adverse and cardiovascular events. This is a cross-sectional, analytical, multicenter and national study with the objective of investigating the factors associated with the lack of BP control in hypertensive in brazilians people. Hypertensive patients over 18 years of age, followed up in 45 outpatient clinics and specialties, public and private, included from September 2013 to October 2015, participated in the study. For data collection, an interview was conducted to fill out a Clinical Form Electronic (eCRF) with information questioned to the participant, anamnesis and physical examination. The following procedures were performed: BP assessment; sociodemographic data; anthropometry; life habits; personal background; family history; associated diseases and conditions; history of AH; clinical evaluation; and adherence to drug treatment (Morisky Scale). Data analysis was performed using the Stata program, version 14.0. Mean and standard deviation, and absolute and relative frequencies were used for descriptive presentation. The Kolmogorov-Smirnov test was applied to verify the distribution of data for the variables and simple and multiple logistic regression to verify the associations with the outcome. A p value was considered significant. 2,643 participants were evaluated, most of them female (55.7%), non-smokers (93.8%), nondrinkers (92.6%), active (74.9%) and had low adherence to drug treatment (57.8%). The mean blood pressure was 137.2 (± 21.5) mmHg and 82.8 (± 12.2) mmHg for systolic and diastolic, respectively. BP was not controlled in 1,226 (46.4%) participants. Among the diseases studied, dyslipidemia was the most frequent (46.9%) and family history of AH was present in more than half of the sample (75.9%). To the uncontrolled BP was associated: age over 60 years (OR: 1.31 [1.11 - 1.55]); practice of irregular physical activity (OR: 1.28 [1.06 - 1.55]); attending the emergency room for hypertensive crises in the last six months (OR: 1.80 [1.46 - 2.22]); increased body mass index (OR: 1.02 [1.01 - 1.04]); low adherence to drug treatment (OR: 1.22 [1.04 - 1.44]) and menopause (OR: 1.36 [1.07 - 1.72]). Fruit consumption (OR: 0.90 [0.85 - 0.94]); presence of dyslipidemia (OR: 0.75 [0.64 - 0.89]), acute myocardial infarction (OR: 0.59 [0.46 - 0.76]) and peripheral arterial disease (OR: 0.52 [0.34 - 0.78]) were negatively associated. The present investigation concluded that the BP control rates were low and the associated factors were related to inadequate lifestyle habits, increased body weight and inappropriate use of drug therapy. The occurrence of some cardiovascular diseases was a protective factor