Prevalence, Awareness, Treatment and Influence of Socioeconomic Variables on Control of High Blood Pressure: Results of the ELSA-Brasil Study

PLoS One. 2015 Jun 23;10(6):e0127382. doi: 10.1371/journal.pone.0127382. eCollection 2015.

Abstract

High blood pressure (HBP) is the leading risk factor for years of life lost in Brazil. Factors associated with HBP awareness, treatment and control need to be understood better. Our aim is to estimate prevalence, awareness, and types of anti-hypertensive treatment and to investigate the association of HBP control with social position. Data of 15,103 (54% female) civil servants in six Brazilian state capitals collected at the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline (2008-2010) were used to estimate prevalence and cross-sectional association of HBP control with education, per capita family income and self-reported race, using multiple logistic regression. Blood pressure was measured by the oscillometric method. 35.8% were classified as presenting HBP; 76.8% of these used anti-hypertensive medication. Women were more aware than men (84.8% v. 75.8%) and more often using medication (83.1% v. 70.7%). Adjusted HBP prevalence was, in ascending order, Whites (30.3%), Browns (38.2%) and Blacks (49.3%). The therapeutic schemes most used were angiotensin-converting enzyme inhibitors, in isolation (12.4%) or combined with diuretics (13.3%). Among those in drug treatment, controlled blood pressure was more likely in the (postgraduate) higher education group than among participants with less than secondary school education (PR = 1.21; 95% CI: 1.14-1.28), and among Asian (PR = 1.21; 95% CI: 1.12-1.32) and 'Whites (PR = 1.19; 95% CI: 1.12-1.26) compared to Blacks. Socioeconomic and racial inequality-as measured by different indicators-are strongly associated with HBP control, beyond the expected influence of health services access.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antihypertensive Agents / therapeutic use
  • Awareness*
  • Brazil / epidemiology
  • Female
  • Humans
  • Hypertension / drug therapy*
  • Hypertension / epidemiology*
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Prevalence
  • Socioeconomic Factors*

Substances

  • Antihypertensive Agents

Grants and funding

The ELSA-Brasil study was supported by the Brazilian Ministry of Health (Science and Technology Department) and the Brazilian Ministry of Science and Technology (Financiadora de Estudos e Projetos and CNPq National Research Council) (grants 01 06 0071.00 RJ, 01 06 0212.00 BA, 01 06 0300.00 ES, 01 06 0278.00 MG, 01 06 0115.00 SP, 01 060010.00 RS). DC received a fellowship from the Conselho Nacional de Desenvolvimento Científico e Tecnológico (National Council for Scientific and Technological Development) under Award Number 300694/2010-5. MSC received a fellowship from the CNPq under Award Number 309692/2013-0 and FAPERJ E-23557/2014. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.