Pressão arterial elevada: Prevalência e determinantes sociodemográficos, comportamentais e clínicos em adultos

Abstract

Non-communicable chronic diseases (NCDs) are a major health problem worldwide, accounting for the high number of deaths. Among the NCDs, systemic arterial hypertension (SAH) stands out, characterized by sustained elevation of blood pressure (BP) and considered as one the main risk factors for the development of cardiovascular diseases (CVD). This thesis aimed to investigate the prevalence of high BP and its sociodemographic, behavioral and clinical determinants in adults. Data from the research "Polymorphism of the leptin receptor gene (rs1137101), obesity and its association with risk factors for cardiovascular diseases in Montes Claros - MG", carried out in 2013, were used. To that end, three studies were conducted. Study 1: The objective was to estimate the prevalence of SAH in the Brazilian adult population through a systematic review with meta-analysis. Cross-sectional population based studies published in Portuguese, English or Spanish between 2010 and 2017 were eligible. Electronic database including PubMed, SciELO, Web of Science and Banco de Dissertações e Teses Brasileiras were searched by two independent reviewers. The methodological quality of the studies was evaluated. The prevalence of SAH in the total population was estimated and stratified by sex. The odds ratio was calculated to assess the association between SAH and gender. A total of 837 studies were identified and 17 were included in the review. The articles included corresponded to 106,606 individuals, 52.8% of them being female, covering all Brazilian regions. A variability was observed between the definition criteria of SAH and BP measurement methods. The estimated prevalence of SAH was 31.0% (95%CI 27.0-35.0), being 35.0% male (95%CI 30.0-40.0) and 27.0% female, (95%CI 22.0-32.0). A negative and significant association between SAH and female gender (PR=0.76, 95%CI 0.68-0.85) was found. Study 2: This study aimed to estimate the prevalence of high BP and to identify its associated factors in adults living in the municipality of Montes Claros - MG. The high BP was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Data on socioeconomic and demographic characteristics, behaviors related to health, anthropometry, self-reported comorbidities and medical checkup for high blood pressure, were collected. The prevalence of high BP was 26.3% (95%CI 23.3-29.4). The adjusted analysis showed a positive and significant association between high BP and male sex, age progression, alcohol consumption, overweight, obesity and dyslipidemia, and showed a negative and significant association between high BP and consumption of chicken meat with skin. Study 3: The objective of this study was to investigate the interrelationships between sociodemographic, behavioral and clinical factors associated with elevated blood pressure in a population of Brazilian adults. Previously a hypothetical model was elaborated in which the variables socioeconomic status, fruit and vegetable consumption, adiposity and BP were analyzed as constructs and the variables age, blood glucose, physical activity, smoking, alcohol consumption and medical control of arterial hypertension were treated as observed variables. We used the confirmatory factorial analysis to construct the models of measurement of the constructs. The structural equation modeling (SEM) was adopted to fit the final model and to estimate the effects of the interrelationships between analyzed variables. It was verified that age exerted a positive direct effect on BP (β=0.37, p<0.001), adiposity (β=0.43, p<0.001), glycemia (β=0.27, p<0.001) and smoking (β=0.31, p<0.001) and negative direct effect on physical activity (β=-0.17, p<0.001) and alcohol consumption (β=-0.09, p=0.041). Adiposity had a positive direct effect on BP (β =0.23, p<0.001) and glycemia (β=0.16, p<0.001) and alcohol consumption produced a positive effect (β=0.09, p=0.005) on adiposity. There was a negative direct effect of fruit and vegetable consumption on BP (β=-0.11, p<0.001) and a positive direct effect of the socioeconomic condition on fruit and vegetable consumption (β=0.45, p<0.001). The structural model was adjusted by the variable medical control of arterial hypertension, which had a negative direct effect on BP (β=-0.09; p=0.045).