Hypertension in a Brazilian Urban Slum Population

Abstract

Low-and middle-income countries account for the majority of hypertension disease burden. However, little is known about the distribution of this illness within subpopulations of these countries, particularly among those who live in urban informal settlements. A cross-sectional hypertension survey was conducted in 2003 among 5649 adult residents of a slum settlement in the city of Salvador, Brazil. Hypertension was defined as either an elevated arterial systolic (≥140 mmHg) or diastolic (≥90 mmHg) blood pressure. Sex-specific multivariable models of systolic blood pressure were constructed to identify factors associated with elevated blood pressure. The prevalence of hypertension in the population 18 years and older was 21 % (1162/5649). Men had 1.2 times the risk of hypertension compared with women (95 % confidence intervals (CI), 1.05, 1.36). Increasing age and lack of any schooling, particularly for women, were also significantly associated with elevated blood pressure (pG0.05). There was also a direct association between men who were black and an elevated blood pressure. Among those who were hypertensive, 65.5 % were aware of their condition, and only 36.3 % of those aware were actively using anti-hypertensive medications. Men were less likely to be aware of their diagnosis or to use medications (pG0.01 for both) than women. The prevalence of hypertension in this slum community was lower than reported frequencies in the non-slum population of Brazil and Salvador, yet both disease awareness and treatment frequency were low. Further research on hypertension and other chronic non-communicable diseases in slum populations is urgently needed to guide prevention and treatment efforts in this growing population.

Differences in the Prevalence of Non-Communicable Disease between Slum Dwellers and the General Population in a Large Urban Area in Brazil

“…A 2012 survey in a Lima, Peru community found lower prevalences of hypertension and DM, but similar prevalences of overweight, obesity, and smoking to our survey [ 35 ]. Serial cross-sectional surveys from a Kenyan slum in 2010 reported similar prevalences of hypertension, a lower prevalence of DM and a higher prevalence of overweight and obesity compared to the present study [ 7 , 16 , 36 ]. Several other studies in Kenyan and Nigerian communities have reported a lower prevalence of hypertension than among those living in Pau da Lima [ 8 , 10 ].…”

“…Existing surveys of NCDs and NCD risk factors in slums tend to focus on individual NCDs. Further, many studies done in urban areas do not disaggregate the population’s health data by slum and non-slums status to allow for the detection of intra-urban health disparities, or even sample from this population [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ].…”

Matão Controlling Hypertension (MatCH) project: Rationale and design

“…Hypertension awareness in Brazil ranges from half to more than two thirds of the population. Although in some Brazilian regions BP control was reported in 67,5% [13] , in most part of the country, BP control is reached in less than 40% of the hypertensive population [24] , [25] , [26] . A better BP control would be expected in Brazil as the Brazilian FHS covers most of the country.…”

Local Actors’ Frames of the Role of Living Conditions in Shaping Hypertension Risk and Disparities in a Colombian Municipality

“…50 Despite the fact that 1 billion of the world's population currently live under slum conditions or in other marginalized urban settlements in poorer countries, 51 research directly tying poor urban living conditions to hypertension in LMICs is still limited. [52][53][54][55] Studies from African cities, some of which may share urban and sociodemographic characteristics with Quibdó, have found an increase in blood pressure in urban compared with rural populations as a result of current urban residence and/or lifetime exposure to urban environments. 39,56,57 Most of these studies suggest that changes in well-established risk factors for hypertension, such as physical inactivity and stress, are involved in this increase.…”