RESUMEN
Resumo O objetivo do artigo é avaliar a prevalência de adesão ao tratamento anti-hipertensivo na população brasileira, com base nos estudos revisados por pares, que utilizaram instrumentos elaborados e/ou adaptados exclusivamente para este fim. Revisão sistemática com meta-análise, baseada nas recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A busca foi realizada nas bases BDENF, SciELO, Cuiden, PsycINFOe, CINAHL, Embase, LILACS, MEDLINE, e nos buscadores acadêmicos AgeLine, Google Scholar e ScienceDirect. O protocolo foi registrado no PROSPERO (CRD42021292689). Modelos de efeitos aleatórios foram usados para meta-análise das prevalências obtidas dos estudos individuais. Incluíram-se 104 estudos na meta-análise sobre tratamento anti-hipertensivo na população brasileira, totalizando 38.299 pacientes. O instrumento mais utilizado foi o teste de Morisky-Green de quatro itens (49,5%). A prevalência de adesão estimada pela foi de 44,4% (IC95%: 39,12%-49,94%, I2 = 91,17, p < 0,001), apresentando alta heterogeneidade. A prevalência de adesão ao tratamento anti-hipertensivo encontrada nos estudos nacionais foi insatisfatória, demonstrando que essa problemática continua sendo um grande desafio.
Abstract This article aims to evaluate the adherence to antihypertensive treatment prevalence in the Brazilian population based on peer-reviewed studies which used instruments exclusively designed and/or adapted for this purpose. A systematic review with meta-analysis based on the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was carried out in the BDENF, SciELO, Cuiden, PsycINFOe, CINAHL, Embase, LILACS, and MEDLINE databases, as well as the AgeLine, Google Scholar and ScienceDirect academic search engines. The protocol was registered with PROSPERO (CRD42021292689). Random effects models were used for a meta-analysis of the prevalence obtained from individual studies. A total of 104 studies were included in the meta-analysis on antihypertensive treatment in the Brazilian population, totaling 38,299 patients. The most used instrument was the four-item Morisky-Green Test (49.5%). The adherence prevalence estimated by the meta-analysis was 44.4% (95%CI: 39.12%-49.94%, I2 = 91.17, p < 0.001), showing high heterogeneity. The adherence to antihypertensive treatment prevalence found in national studies was unsatisfactory, demonstrating that this problem continues to be a major challenge.
RESUMEN
This article aims to evaluate the adherence to antihypertensive treatment prevalence in the Brazilian population based on peer-reviewed studies which used instruments exclusively designed and/or adapted for this purpose. A systematic review with meta-analysis based on the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was carried out in the BDENF, SciELO, Cuiden, PsycINFOe, CINAHL, Embase, LILACS, and MEDLINE databases, as well as the AgeLine, Google Scholar and ScienceDirect academic search engines. The protocol was registered with PROSPERO (CRD42021292689). Random effects models were used for a meta-analysis of the prevalence obtained from individual studies. A total of 104 studies were included in the meta-analysis on antihypertensive treatment in the Brazilian population, totaling 38,299 patients. The most used instrument was the four-item Morisky-Green Test (49.5%). The adherence prevalence estimated by the meta-analysis was 44.4% (95%CI: 39.12%-49.94%, I2 = 91.17, p < 0.001), showing high heterogeneity. The adherence to antihypertensive treatment prevalence found in national studies was unsatisfactory, demonstrating that this problem continues to be a major challenge.
O objetivo do artigo é avaliar a prevalência de adesão ao tratamento anti-hipertensivo na população brasileira, com base nos estudos revisados por pares, que utilizaram instrumentos elaborados e/ou adaptados exclusivamente para este fim. Revisão sistemática com meta-análise, baseada nas recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A busca foi realizada nas bases BDENF, SciELO, Cuiden, PsycINFOe, CINAHL, Embase, LILACS, MEDLINE, e nos buscadores acadêmicos AgeLine, Google Scholar e ScienceDirect. O protocolo foi registrado no PROSPERO (CRD42021292689). Modelos de efeitos aleatórios foram usados para meta-análise das prevalências obtidas dos estudos individuais. Incluíram-se 104 estudos na meta-análise sobre tratamento anti-hipertensivo na população brasileira, totalizando 38.299 pacientes. O instrumento mais utilizado foi o teste de Morisky-Green de quatro itens (49,5%). A prevalência de adesão estimada pela foi de 44,4% (IC95%: 39,12%-49,94%, I2 = 91,17, p < 0,001), apresentando alta heterogeneidade. A prevalência de adesão ao tratamento anti-hipertensivo encontrada nos estudos nacionais foi insatisfatória, demonstrando que essa problemática continua sendo um grande desafio.
Asunto(s)
Antihipertensivos , Hipertensión , Cumplimiento de la Medicación , Brasil , Humanos , Antihipertensivos/uso terapéutico , Antihipertensivos/administración & dosificación , Cumplimiento de la Medicación/estadística & datos numéricos , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , PrevalenciaRESUMEN
OBJECTIVE: To evaluate and identify variables associated with the control of hypertension and adherence to antihypertensive drug treatment in a group of patients with hypertension monitored in a specialized, highly complex outpatient service. METHODS: A prospective, cross-sectional study was carried out in the hypertension unit of a tertiary teaching hospital. Patients diagnosed with hypertensive aged 18 years and over and accompanied for at least six months were included in the study. Patients with secondary hypertension and pregnant women were excluded. The sample consisted of 253 patients. Adherence/concordance to antihypertensive treatment was assessed using the Morisky Green Levine Scale. Blood pressure control was set for values less than 140/90 mmHg. Variables with p≤0.20 in univariate analysis were included in multiple logistic regression. The level of significance adopted was p ≤0.05. RESULTS: Most of patients were white, married and women, with a mean age of 65 (13.3) years old, low income, and education levels. Blood pressure control and adherence were observed in 69.2% and 90.1% of the patients, respectively. Variables that were independently associated with blood pressure control were (OR, odds ratio; CI, 95% confidence interval): married marital status (OR 2.3; CI 1.34-4.28), use of calcium channel blockers (OR 0.4; CI 0.19-0.92) and number of prescribed antihypertensive drugs (OR 0.78; CI 0.66-0.92). Adherence was not associated with any of the variables studied. CONCLUSION: There was a high frequency of patients with satisfactory adherence to antihypertensive drug treatment. Blood pressure control was less frequent and was associated with social and treatment-related factors.
RESUMEN
Abstract Introduction: Arterial hypertension is a disease that has a high impact on cardiovascular mortality and morbidity; however, it is still insufficiently controlled. Objectives: To assess hypertension control in patients seen at a specialized clinic and to identify associated variables. Method: Cross-sectional study involving the analysis of medical records from 782 patients treated in a highly complex outpatient clinic. Inclusion criteria: age ≥18 years, diagnosed with hypertension, in treatment ≥6 months. Patients with secondary hypertension (104) and incomplete data (64) were excluded. The main outcome was blood pressure control (systolic <140 and diastolic <90 mmHg). The independent variables studied were: sociodemographic and clinical characteristics (use of drugs, comorbidities and laboratory tests). Pearson's χ2 tests, Fisher's test, Student's t and Wilcoxon-Mann-Whitney tests were performed in the bivariate analysis and logistic regression in the multiple analyses, adopting p≤0.05. Results: The prevalence of hypertensive control was 51.1%. It was associated with a lack of control: body mass index (OR = 1.038; 95% CI = 1.008 - 1.071), history of stroke (OR = 0.453; 95% CI = 0.245 - 0.821), left ventricular hypertrophy (OR = 1.765; 95% CI = 1.052 - 3.011), and number of medications (OR = 1.082; 95% CI = 1.033 - 1.136). Conclusion: About half of the hypertensive patients had their blood pressure controlled; clinical variables and target organ damage were associated with the control.
Resumo Introdução: A hipertensão arterial é uma doença com alto impacto na mortalidade e morbidade cardiovascular, contudo ainda demonstra insuficientes taxas de controle. Objetivos: Avaliar o controle da hipertensão em pacientes atendidos em um ambulatório especializado e identificar variáveis associadas. Método: Estudo transversal com análise do prontuário de 782 pacientes atendidos em um ambulatório de alta complexidade. Critérios de inclusão: idade ≥ 18 anos e diagnóstico de hipertensão em tratamento ≥ 6 meses. Foram excluídos hipertensão secundária (104) e dados incompletos (64). O desfecho principal foi o controle da pressão arterial (Sistólica < 140 e diastólica < 90 mmHg). As variáveis independentes estudadas foram: características sociodemográficas e clínicas (uso de medicamentos, comorbidades e exames laboratoriais). Realizou-se testes χ2 de Pearson, teste Fisher, t de Student e Wilcoxon-Mann-Whitney na análise bivariada e Regressão Logística na análise múltipla, adotando p ≤ 0,05. Resultados: A prevalência de controle dos hipertensos foi 51,1%. Associou-se à falta de controle: índice de massa corporal (OR = 1,038; IC95% = 1,008 - 1,071), histórico de acidente vascular encefálico (OR = 0,453; IC95% = 0,245 - 0,821) e hipertrofia ventricular esquerda (OR = 1,765; IC95% = 1,052 - 3,011), e número de medicamentos (OR = 1,082; IC95% = 1,033 - 1,136). Conclusão: Cerca da metade dos hipertensos estava com pressão arterial controlada e variáveis clínicas e lesão em órgão alvo associaram-se ao controle.
Asunto(s)
Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Presión Sanguínea , Estudios Transversales , Hipertrofia Ventricular Izquierda , Monitoreo Ambulatorio de la Presión Arterial , Instituciones de Atención AmbulatoriaRESUMEN
INTRODUCTION: Arterial hypertension is a disease that has a high impact on cardiovascular mortality and morbidity; however, it is still insufficiently controlled. OBJECTIVES: To assess hypertension control in patients seen at a specialized clinic and to identify associated variables. METHOD: Cross-sectional study involving the analysis of medical records from 782 patients treated in a highly complex outpatient clinic. Inclusion criteria: age ≥18 years, diagnosed with hypertension, in treatment ≥6 months. Patients with secondary hypertension (104) and incomplete data (64) were excluded. The main outcome was blood pressure control (systolic <140 and diastolic <90 mmHg). The independent variables studied were: sociodemographic and clinical characteristics (use of drugs, comorbidities and laboratory tests). Pearson's χ2 tests, Fisher's test, Student's t and Wilcoxon-Mann-Whitney tests were performed in the bivariate analysis and logistic regression in the multiple analyses, adopting p≤0.05. RESULTS: The prevalence of hypertensive control was 51.1%. It was associated with a lack of control: body mass index (OR = 1.038; 95% CI = 1.008 - 1.071), history of stroke (OR = 0.453; 95% CI = 0.245 - 0.821), left ventricular hypertrophy (OR = 1.765; 95% CI = 1.052 - 3.011), and number of medications (OR = 1.082; 95% CI = 1.033 - 1.136). CONCLUSION: About half of the hypertensive patients had their blood pressure controlled; clinical variables and target organ damage were associated with the control.
Asunto(s)
Hipertensión , Adolescente , Instituciones de Atención Ambulatoria , Presión Sanguínea , Monitoreo Ambulatorio de la Presión Arterial , Estudios Transversales , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Hipertrofia Ventricular IzquierdaRESUMEN
Introdução: A hipertensão arterial é a principal causa de morbimortalidade cardiovascular e o controle da hipertensão arterial é a forma mais eficaz de evitar as complicações cardiovasculares e diminuir a morbimortalidade. Porém, as taxas de controle em nosso meio ainda são insatisfatórias e os dados disponíveis são na maioria de estudos realizados na atenção básica. Objetivo: Avaliar o controle da hipertensão arterial em um grupo de hipertensos acompanhados em um serviço ambulatorial especializado. Método: Estudo exploratório, prospectivo, transversal, desenvolvido na Unidade de Hipertensão de um hospital de ensino da cidade de São Paulo. Os critérios de inclusão foram: idade 18 anos, em acompanhamento no ambulatório há pelo menos seis meses e que aceitaram participar voluntariamente do estudo, assinando o Termo de Consentimento Livre e Esclarecido. Foram excluídos pacientes com hipertensão secundária, gestantes e aqueles que apresentaram comprometimento que impedia a realização da entrevista. O cálculo estatístico da amostra foi baseado na taxa de controle de 60% para um poder de teste de 80% e nível de significância de 5%, resultando em 253 participantes. Foram realizadas entrevistas para coleta de dados biossociais, etilismo, tabagismo, atividade física, comorbidades, medicamentos em uso e avaliação da adesão ao tratamento pela Escala de Adesão Terapêutica de Oito Itens de Morisky. Também foram feitas medidas antropométricas, avaliação de bioimpedância e de exames laboratoriais. O controle da pressão arterial pela medida realizada por enfermeira foi para valores <140 mmHg para pressão sistólica e <90 mmHg para a pressão diastólica. O nível de significância utilizado foi de p<0,05. Resultados: A prevalência de controle da pressão arterial foi de 69,2% e 82,2% apresentaram alta adesão ao tratamento farmacológico. A amostra foi constituída de 61,7% mulheres, 63,2% brancos, 52,8% casados, idade de 65,0 (13,3) anos, 47% do estrato socioeconômico C2, 44,3% com ensino médio completo e renda mensal de 2.302,00 (1.781,00) reais. Observou-se que 7,5% eram tabagistas, 40,3% faziam uso de bebida alcoólica e 38,3% sedentários. O índice de massa corporal foi de 29,5 (5,3) Kg/m2 e 81,4% apresentaram sobrepeso ou obesidade. Dentre as comorbidades avaliadas, 75,0% tinham histórico de dislipidemia, 40,7% diabetes, 19,0% doença renal crônica, 13,4% insuficiência cardíaca, 8,7% acidente vascular encefálico e 8,3% infarto agudo do miocárdio. Os hipertensos controlados foram estatisticamente diferentes dos não controlados (p<0,05), respectivamente, em relação a: estado civil casado (58,9% vs 39,0%); índice de massa corporal [29,0 (5,4) vs 30,6 (4,9) Kg/m2 ]; circunferência da cintura [101,6 (13,7) vs 101,7 (10,4) cm]; gordura corporal [36,1 (10,5) vs 38,1 (9,3)]; percentual de gordura corporal classificada como normal (26,9% vs 9,0%); idade corporal [64,9 (12,0) vs 68,1 (11,1)]; número de medicamentos [7,6 (3,8) vs 9,1 (4,1)]; e número de anti- hipertensivos [3,4 (1,7) vs 4,5 (2,1)]. Os hipertensos controlados utilizavam em menor frequência os anti-hipertensivos: bloqueadores dos canais de cálcio (61,7% vs 84,6%), inibidores adrenérgicos betabloqueador (44,0% vs 64,1%), agentes de ação central (12,6% vs 23,1%), vasodilatadores (5,7% vs 19,2%). A análise de regressão logística indicou associação independente do controle dos hipertensos com as seguintes variáveis (OR , odds ratio; IC, intervalo de confiança de 95%): estado civil casado (OR 2,3; IC 1,34 4,28), uso de bloqueadores dos canais de cálcio (OR 0,4; IC 0,19 - 0,92) e número de anti-hipertensivo prescritos (OR 0,78; IC 0,66 0,92 ). Conclusão: Apesar da presença de importantes fatores de risco nos hipertensos avaliados, o controle e a adesão ao tratamento farmacológico apresentaram-se otimizados.
Introduction: Hypertension is the leading cause of cardiovascular morbidity and mortality, and controlling hypertension is a more effective way to prevent cardiovascular complications and decreased morbidity and mortality. However, as control rates in our country are still unsatisfactory and available data are in most studies conducted in primary care. Objective: To evaluate the control of hypertension in a group of hypertensive patients followed up in a specialized outpatient clinic. Method: Exploratory, prospective, cross-sectional study, developed at the Hypertension Unit of a teaching hospital in the city of São Paulo. Inclusion criteria were: age 18 years, followed at the outpatient clinic for at least six months and who agreed to participate voluntarily in the study, signing the Informed Consent Form. Patients with secondary hypertension, pregnant women and those who presented impairment that prevented the interview were excluded. Statistical calculation of the sample was based on the 60% control rate for 80% test power and 5% significance level, resulting in 253 participants. Interviews were conducted to collect biosocial data, alcohol use, smoking, physical activity, comorbidities, medications in use, and treatment adherence assessment by the Morisky Eight-Item Therapeutic Adherence Scale. Anthropometric measurements, bioimpedance assessment and laboratory tests were also performed. Blood pressure control by the nurse measurement was <140 mmHg for systolic pressure and <90 mmHg for diastolic pressure. The significance level used was p <0.05. Results: The prevalence of control was 69.2% and 82.2% showed high adherence to pharmacological treatment. The sample consisted of 61.7% women, 63.2% whites, 52.8% married, age 65.0 (13.3) years, 47% belonging to C2 socioeconomic status, 44.3% had completed high school and monthly income of R$2.302.00 (1.781.00). Regarding risk factors / lifestyle, 7.5% reported being smoker, 40.3% used alcohol and 38.3% were sedentary. The body mass index was 29.5 (5.3) kg / m2. It was also found that 81.4% of hypertensive patients were overweight or obese. Among the comorbidities evaluated, 75.0% had a history of dyslipidemia, 40.7% diabetes, 19.0% chronic kidney disease, 13.4% heart failure, 8.7% stroke and 8.3% acute myocardial infarction. The controlled and uncontrolled hypertensive patients were distinct (p <0.05) in relation to: married marital status (58.9% vs 39.0%); body mass index [29.0 (5.4) vs 30.6 (4.9) kg / m2]; waist circumference [101.6 (13.7) vs 101.7 (10.4) cm]; body fat [36.1 (10.5) vs 38.1 (9.3)]; body fat percentage classified as normal (26.9% vs. 9.0%); body age [64.9 (12.0) vs 68.1 (11.1)]; number of medicines [7.6 (3.8) vs 9.1 (4.1)]; and number of antihypertensive drugs [3.4 (1.7) vs 4.5 (2.1)]. The controlled hypertensives used antihypertensives less frequently: calcium channel blockers (61.7% vs 84.6%), beta- blocker adrenergic inhibitors (44.0% vs 64.1%), centrally acting agents (12 , 6% vs 23.1%), vasodilators (5.7% vs 19.2%). Logistic regression analysis indicated independent control association with the following variables (OR, odds ratio; CI, 95% confidence interval): married marital status (OR 2.3; CI 1.34 - 4.28), blockers calcium channels (OR 0.4; CI 0.19 - 0.92) and number of antihypertensive drugs in use (OR 0.78; CI 0.66 - 0.92). Conclusion: Despite the presence of important risk factors in the hypertensive patients evaluated, the control and adherence to pharmacological treatment were optimized.