Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza, CE, Brasil.
Serviço de Cardiologia, Hospital Universitário Walter Cantídio, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil.
Braz J Med Biol Res. 2024 Feb 9;57:e12937. doi: 10.1590/1414-431X2023e12937. eCollection 2024.
The treatment of arterial hypertension (AH) contributes to the reduction of morbidity and mortality. Gender differences are likely to play a role, as non-treatment is associated with clinical and sociodemographic aspects. The aim of this study was to investigate the factors associated with non-treatment of AH and gender differences in hypertensive individuals from the ELSA-Brasil cohort. The study was conducted with 5,743 baseline hypertensive cohort participants. AH was considered if there was a previous diagnosis or if systolic blood pressure (SBP) was ≥140 and/or diastolic BP (DBP) was ≥90 mmHg. Sociodemographic and anthropometric data, lifestyle, comorbidities, and use of antihypertensive medications were evaluated through interviews and in-person measurements. Treatment with renin-angiotensin-aldosterone system inhibitors (RAASi) or other antihypertensive medications and non-treatment were evaluated with multivariate logistic regression. Non-treatment was observed in 32.8% of hypertensive individuals. Of the 67.7% treated individuals, 41.1% received RAASi. Non-treatment was associated with alcohol consumption in women (OR=1.41; 95%CI: 1.15-1.73; P=0.001), lowest schooling level in men (OR=1.70; 95%CI: 1.32-2.19; P<0.001), and younger age groups in men and women (strongest association in males aged 35-44 years: OR=4.58, 95%CI: 3.17-6.6, P<0.001). Among those using RAASi, a higher proportion of white, older individuals, and with more comorbidities was observed. The high percentage of non-treatment, even in this civil servant population, indicated the need to improve the treatment cascade for AH. Public health policies should consider giving special attention to gender roles in groups at higher risk of non-treatment to reduce inequities related to AH in Brazil.
动脉高血压（AH）的治疗有助于降低发病率和死亡率。性别差异可能起到一定作用，因为未进行治疗与临床和社会人口统计学方面有关。本研究的目的是调查与 AH 未治疗相关的因素以及 ELSA-Brasil 队列中高血压个体的性别差异。该研究纳入了 5743 名基线高血压队列参与者。如果有既往诊断或收缩压（SBP）≥140mmHg 和/或舒张压（DBP）≥90mmHg，则认为存在 AH。通过访谈和面对面测量评估社会人口统计学和人体测量学数据、生活方式、合并症和使用抗高血压药物的情况。使用肾素-血管紧张素-醛固酮系统抑制剂（RAASi）或其他抗高血压药物进行治疗和未治疗的情况，通过多变量逻辑回归进行评估。32.8%的高血压患者未进行治疗。在接受治疗的 67.7%患者中，有 41.1%接受了 RAASi。女性饮酒（比值比[OR]=1.41；95%可信区间[CI]：1.15-1.73；P=0.001）、男性受教育程度最低（OR=1.70；95%CI：1.32-2.19；P<0.001）以及男性和女性的年龄较小（年龄在 35-44 岁的男性关联最强：OR=4.58，95%CI：3.17-6.6，P<0.001）与未治疗相关。在使用 RAASi 的患者中，观察到更高比例的白人、年龄较大的患者和合并症更多。即使在公务员人群中，未治疗的比例仍然很高，这表明需要改善 AH 的治疗级联。公共卫生政策应考虑特别关注未治疗风险较高的群体中的性别角色，以减少巴西与 AH 相关的不平等现象。
