Hypertension evaluated in the public and private Brazilian health system hypertension in public and private service

Abstract

IntroductionHypertension (HT) remains the leading cause of death worldwide. In Brazil it is estimated that 35% of the adult population has HT and that about 20% of these have blood pressure values within the targets recommended for the reduction of cardiovascular risk. There are some data that point to different control rates in patients treated by cardiologists in public and private referral center and this is an important point to be investigated and discussed.ObjectiveTo compare sociodemographic characteristics, body mass index (BMI), antihypertensive (AH) drugs, blood pressure (BP) and control rate in public (PURC) and private (PRRC) referral centers.MethodologyA cross-sectional multicenter study that analyzed data from hypertensive patients assisted by the PURC (one in Midwest Region and other in Northeast region) and PRRC (same distribution). Variables analyzed: sex, age, BMI, classes, number of AH used and mean values of systolic and diastolic BP by office measurement and home blood pressure measurement (HBPM). Uncontrolled hypertension (HT) phenotypes and BP control rates were assessed. Descriptive statistics and χ2 tests or unpaired t-tests were performed. A significance level of p < 0.05 was considered.ResultsA predominantly female (58.9%) sample of 2.956 patients and a higher prevalence of obesity in PURC (p < 0.001) and overweight in PRRC (p < 0.001). The mean AH used was 2.9 ± 1.5 for PURC and 1.4 ± 0.7 for PRRC (p < 0.001). Mean systolic and diastolic BP values were higher in PURC as were rates of uncontrolled HT of 67.8% and 47.6% (p < 0.001) by office measurement and 60.4% and 35.3% (p < 0.001) by HBPM in PURC and PRRC, respectively.ConclusionPatients with HT had a higher prevalence of obesity in the PURC and used almost twice as many AH drugs. BP control rates are worse in the PURC, on average 15.3 mmHg and 12.1 mmHg higher than in the PRRC by office measurement.

Programa Nacional Para Aumentar a Adesão Do Cardiologista Ao Uso Da Mrpa, Reforçar a Importância No Seguimento Das Diretrizes Nacionais E Avaliar O Impacto Nas Taxas De Controle Da Hipertensão Arterial

“…[2][3][4] Sabidamente, a adoção de estratégias relacionadas como as medidas domiciliares da pressão arterial, é capaz de aumentar o cuidado e adesão do paciente ao uso dos fármacos anti-hipertensivos, além de permitir que o médico conheça melhor os diferentes fenótipos da doença hipertensiva e estabeleça estratégias de tratamento mais precisas. [5][6][7] Também é consenso a importância do uso de fármacos anti-hipertensivos de meia vida longa e em combinações, preferencialmente em um único comprimido, como estratégia capaz de aumentar a adesão. 5,8 Dessa forma, medidas que estimulem o uso de medidas domiciliares da pressão arterial de forma mais frequente assim como o uso de fármacos em combinações fixas e de meia vida longa, têm o potencial de melhorar as taxas de controle da HA.…”