Health behaviors and hypertension control: the results of ELSI-BRASIL

Association of health behaviors in life's essential 8 and hypertension in adolescents: a cross-sectional study from the NHANES database

BACKGROUND

Hypertension is a common condition during adolescence with increasing prevalence globally, alongside the epidemic of unhealthy lifestyles and obesity. Health behaviors have been shown to be associated with hypertension risk in adults. Life's essential 8 (LE8), as a comprehensive indicator to evaluate cardiovascular health (CVH), includes 4 health factors and 4 health behaviors. This study aims to evaluate the association between health behaviors defined in LE8 and hypertension among adolescents.

METHODS

Data of this study were extracted from the National Health and Nutrition Examination Surveys (NHANES) 2007-2018. Health behaviors of LE8 including diet, physical activity and tobacco smoke exposure. The outcome was the odd of hypertension in adolescents. The weighted univariate and multivariate logistic regression was unitized to explore the relationship between CVH score and hypertension in adolescents. Subgroup analysis and sensitivity analysis were further conducted to explore the association across different populations.

RESULTS

Totally 3,941 adolescents aged 12-17 years were included, with the mean aged of 14.48 ± 0.04 years. Of whom, 203 (5.15%) had hypertension. After adjusted all covariates, high CVH score was associated with the lower odds of hypertension (OR = 0.32, 95%CI: 0.17-0.61), especially in boys (OR = 0.23, 95%CI: 0.11-0.51) and adolescents with overweight/obesity (OR = 0.24, 95%CI: 0.10-0.56). Sensitivity analysis reported that the association between CVH score and the odds of hypertension was also robust after excluding self-reported hypertension and medication taking (OR = 0.37, 95%CI: 0.18-0.74).

CONCLUSION

A high CVH score, indicating a greater adherence of health behaviors, was associated with a reduced odds of hypertension, especially among boys and overweight/obesity adolescents. Large-scale prospective cohort studies are needed to further explore the association between health behaviors defined in LE8 and hypertension among adolescents.

Inclusion of Potentially Inappropriate Medicines for the Older Adults in the Brazilian Consensus in Accordance with International Criteria

AIM

The use of potentially inappropriate medications (PIM) can impair the safety and effectiveness of pharmacotherapy in the older adults. Thus, several countries have lists and criteria to indicate these drugs, in order to promote the safety of prescription and the rational use of drugs in geriatric practice.

OBJECTIVE

This study sought to contribute to the inclusion of PIM for the older adults in the Brazilian criterion (BCPIM/2016) - current list used in Brazil and reference in Latin American countries - through expert approval, comparing convergences with international AGS lists BEERS/2019, STOPP/START/2015, PRISCUS/2010 and EU (7)-PIM List/2015.

METHODS

This is a critical analysis of potentially inappropriate medications for use in the older adults present in the list of Brazilian criteria, together with their absence of some drugs that are on international lists (BEERS/2019; Priscus/2010; Stopp/Start/2015; EU7-PIM list/2015). This study was subdivided in 6 stages: selection of national criteria, classification of drugs according to Anatomic Therapeutic Chemical, comparison between BCPIM/2016 with international lists, selection of drugs not included in the Brazilian list, selection of experts for evaluation and suggestions about drugs not included in the Brazilian list and the synthesis of the analysis carried out by the specialists.

RESULTS

We cataloged 66 drugs marketed in Brazil that are on international lists, but not in the Brazilian consensus, of which 24 were validated by experts as necessary for inclusion in this consensus, considering the risks and benefits in health care for the older adults. However, the lists have divergences and similarities between them. We observed that eight drugs were common to all criteria studied, mainly related to the nervous system.

CONCLUSION

The results suggest the need for periodic validation of PIM against research clinics, new drugs and the inclusion of this agenda by the Ministry of Health in the revision of the National List of Essential Drugs and other Clinical Protocols and Therapeutic Prescription Guidelines for the older adults.

Blood Pressure Control and Adherence to Drug Treatment in Patients with Hypertension Treated at a Specialized Outpatient Clinic: A Cross-Sectional Study

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.

Hipertensión arterial autorreferida en adultos mayores brasileños: uso de medicación y recomendaciones para el control

Objetivo Estimar la prevalencia de hipertensión arterial (HA) autorreferida y del uso de medicación en los adultos mayores brasileños (≥65 años), según las características sociodemográficas, y evaluar el uso de los servicios de salud y de las recomendaciones de los médicos y profesionales de salud para el control de la enfermedad. Método Estudio transversal con datos de la Pesquisa Nacional de Salud del 2013 (n=7.712). Resultados La prevalencia de HA fue del 54,1%, con diferencia entre los sexos. En los hombres, la prevalencia de HA fue mayor en las regiones Sur y Sudeste, y en las mujeres fue mayor en los subgrupos de 75 a 79 años y de menor escolaridad. El uso de medicación para la HA fue mencionado por el 91,7%, sin diferencia entre los sexos. Las mujeres fueron diagnosticadas con más precocidad (≤39 años) que los hombres (≥65 años). Conclusión El mantenimiento de una alimentación saludable y el consumo reducido de sal se observaron con mayor frecuencia en las mujeres. Los resultados destacan la necesidad de intervenciones para promover el autocuidado, sobre todo entre los hombres.

Blood pressure control of hypertensive patients followed in a high complexity clinic and associated variables

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.

Factors Associated With Positive Self-Rated Health: Comparing Older Adults in Brazil and in Portugal

Introduction: Self-rated health is a multidimensional health indicator and a predictor of adverse events in old age. Answers to this assessment are influenced by social, cultural and personality factors. Aim: Exploring common and distinctive characteristics of Brazilian and Portuguese older adults aged 70 and over regarding positive self-rated health according to sociodemographic variables, to functional capacity, to independent performance of basic activities of daily living and to neuroticism, as well as analyzing associations between positive self-rated health and these variables. Methods: The present paper is a comparative and cross-sectional study based on secondary data contained in the databases of the FIBRA (Frailty in Brazilian Older Adults) follow-up study, with 418 Brazilian older adults, and of the DIA (From Disability to Activity: The Challenge of Aging) study, with 380 Portuguese older adults. Both samples had higher percentages of women: 68.4% for Portugal and 69.9% for Brazil. The Brazilian sample had a higher average age (80.31 ± 4.67) than the Portuguese sample (76.80 ± 5.28). Results: The Portuguese older adults had better overall cognition scores, higher handgrip strength and higher neuroticism values than the Brazilian older adults. In the simple and multiple logistic regression analyses, it was found that among Brazilian older adults, subjects with higher scores in the MMSE (OR 1.16; 95% CI 1.08-1.24), regardless of ADL performance (OR 2.13; 95% CI 1.31-3.47) and with scores 24-29 (OR 1.92; 95% CI 1.07-3.43) or 11-23 (OR 2.09; 95% CI 1.15-3.79) in neuroticism were more likely to assess their health as very good/good. On the other hand, the Portuguese older adults with intermediate 24-9 (OR 2.38; 95% CI 1.31-4.33) or low 11-23 (OR 5.31; 95% CI 2.69-10.45) scores in neuroticism were more likely to evaluate their health as very good/good. Conclusion: Based on the findings of the present study and on the existing literature, it may be said that it is possible for people to age while keeping a positive perception of their own health, even in advanced old age; comparisons between the above-mentioned countries, however, point to the need for investments in healthcare systems so that older adults may enjoy greater physical independence and improved mental health.

Factors associated with not adopting healthy behavior among hypertensive individuals: a population-based study in Brazil

Adoption of a healthy lifestyle is strongly recommended for the control of hypertension, but professional advice alone does not ensure uptake of healthy behavior. Therefore, this study aimed to investigate the factors-associated with non-adoption of healthy behaviors among individuals with a medical diagnosis of hypertension. It was a cross-sectional study using data from the National Health Survey (PNS) carried out in Brazil in 2013, based on interviews with adults (≥18 years) (n = 60,202). The outcome variable was the non-adoption-two or fewer-of healthy behaviors (regular physical activity, recommended consumption of fruit and vegetables, no excessive alcohol consumption, no smoking, and very low/low salt intake [self-perceived]). A logistic regression model was used to verify the factors-associated with non-adoption of healthy behaviors. Approximately 64% of the study sample did not adopt healthy behaviors, i.e., they adopted two or fewer healthy habits. The most frequently mentioned healthy behaviors were not drinking excessively (91.5%), followed by not smoking (86%). Short time since disease diagnosis (OR = 1.20, 95% CI: 1.01-1.43), not using antihypertensive medication (OR = 1.38, 95% CI: 1.13-1.68), not making regular doctor visits (OR = 1.43, 95% CI: 1.23-1.65), and good self-rated health (OR = 1.16, 95% CI: 1.01-1.36) increased the chance of individuals not adopting healthy behaviors compared with their respective reference categories, independently of gender, age, schooling, and economic status. Counseling strategies should consider patient particularities, and health professionals need to be aware of issues that can interfere with the adoption of healthy behaviors of hypertensive patients.