How well is hypertension managed
in the community? A population-based
survey in a Brazilian city
O mane jo d a hip e rte nsão arte rial sistê mic a
na c o munid ad e : Estud o d e b ase p o p ulac io nal
e m uma c id ad e b rasile ira
1 Dep artam en to d e Med icin a Socia l, Fa cu ld a d e d e M ed icin a , Un iv ersid a d e Fed era l d e Pelot a s. Av. Du q u e d e Ca x ia s 250, Pelot a s, RS
96030- 000, Bra sil Rob ert o X. Piccin i 1 Cesa r G. Vict ora 1
Abstract Th ere is u su ally lit t le in form at ion av ailable on h ow w ell h yp ert en siv e in d iv id u als are m an aged at t h e com m u n it y lev el. Th is su rvey m easu red t h e frequ en cy of h yp ert en sion in a m ed i-u m -siz ed Braz ilian cit y by st i-u d yin g a cli-u st er sam p le of 1657 ad i-u lt s aged 20-69 years. Th e 328 h yp ert en siv es (19.8%) a n sw ered a q u est ion n a ire on t h e k n ow led ge a n d m a n a gem en t of t h eir con d it ion . Tw ot h ird s w ere a w a re of t h eir st a t u s a n d m ore t h a n h a lf w ere on a n t ih yp ert en sive m ed -ica t ion , b u t on ly on e- t h ird h a d t h eir b lood p ressu re u n d er con t rol. Ph ysicia n s fa iled t o a d v ise a la rge p rop ort ion of t h eir p a t ien t s a bou t t h e n eed t o lose w eigh t , t a k e ex ercise, a n d qu it sm ok in g. Alt h ou gh la b ora t ory t est s w ere ca rried ou t in m ost p a t ien t s, fu n d oscop y a n d ch est X- ra ys w ere p erform ed in few er t h a n 50%. Con t in u ed ca re by t h e sa m e p h ysicia n w a s t h e on ly fa ct or sign ifi-ca n t ly a ssocia t ed w it h com p en sa t ed h igh b lood p ressu re (rela t iv e risk for n ot h a v in g con t in u ed care = 1.35; 95% CI = 1.02-1.71). High lev els of absen t eeism , red u ct ion of t h e w ork load , an d early ret irem en t w ere fou n d am on g t h e in d iv id u als w it h h igh blood p ressu re.
Key words Hyp ert en sion ; Blood Pressu re; Ep id em iology; Risk Fa ct ors
Resumo Há p ou ca s in form a ções d isp on íveis a resp eit o d o m a n ejo d e p a cien t es h ip ert en sos n a com u n id a d e. Esse est u d o m ed e a freq ü ên cia d e h ip ert en sã o em u m a cid a d e d e m éd io p ort e d o Bra sil a o est u d a r u m a a m ost ra a lea t ória d e 1.657 a d u lt os com id a d e en t re 20 e 69 a n os. Os 328 h ip erten sos (19,8%) en con trad os foram su bm etid os a u m qu estion ário qu e in vestigava o con h eci-m en t o a resp eit o d e su a con d içã o e d a d os d o eci-m a n ejo d est e p rob leeci-m a . D ois t erços d eles sa b ia eci-m ser h ip ert en sos, m a is d a m et a d e u sa va m ed ica çã o p a ra h ip ert en sã o, m a s a p en a s u m t erço a p resen t a v a cifra s t en sion a is con t rola d a s. Os m éd icos n ã o recom en d a ra m , p a ra m u it os d os seu s p a -cien t es, realiz arem ex ercícios físicos, aban d on ar o t abagism o e red u z irem o p eso corp oral. Em bo-ra ex a m es la b obo-ra t oria is t en h a m sid o rea liz a d os em m u it os p a cien t es, ex a m e d e fu n d o d e olh o e Rx d e t óra x fora m feit os em m en os d e 50%. Cu id a d o m éd ico con t in u a d o p elo m esm o m éd ico foi o ú n ico fat or sign ificat iv am en t e associad o com cifras t en sion ais con t rolad as (risco relat iv o p ara n ã o t er cu id a d o m éd ico con t in u a d o = 1,35, com in t erv a lo d e con fia n ça d e 95% d e 1,02 a 1,71). N íveis elev ad os d e absen t eism o, red u ção d a carga d e t rabalh o e ap osen t ad oria p recoce foram re-v ela d os en t re os h ip ert en sos.
Introduction
In t h e St a t e o f Rio Gra n d e d o Su l, in so u t h e r n Br a zil, c a rd iova s c u la r d is e a s e s a re t h e m a in c a u s e s o f d e a t h in a d u lt s (M S, 1992). H yp e r -t e n s io n is a u n ive r s a lly im p o r -t a n -t r is k fa c -t o r fo r t h e se d ise a se s (Co st a ,1983; Du n ca n , 1991; Pea ch & Heller, 1984).
In o rd er to p reven t su ch d ea th s, it is essen t ia l t h a t h yp e rt e n sive s re ce ive a d e q u a t e m a n -a ge m e n t fr o m h e -a lt h c -a re se r vic e s (Cr u ic k-sh a n k e t a l., 1987; Th e La n c e t , 1985; Am e r y, 1985; H D FPCG, 1982). Howe ve r, st u d ie s fro m o th er co u n tries h a ve sh own th a t h yp erten sives a re often u n a wa re of th eir d isea se. Even a m on g t h o se wh o kn ow t h e ir co n d it io n , m a n y d o n o t co m p ly with th e reco m m en d ed trea tm en t, a n d o f t h o se u n d e r t h e ra p y, a fa ir p r o p o r t io n re -m a in u n co n tro lled (Ped o e, 1982).
Po p u la t io n -b a se d st u d ie s a re h igh ly u se fu l for b oth eva lu a tin g th e con trol of h yp erten sion a n d p la n n in g se r vic e s. St u d ie s re st r ic t e d t o h e a lt h se r vic e s m a y p r ovid e in fo r m a t io n o n q u a lity o f ca re fo r u se rs b u t will fa il to id e n tify h yp e rt e n sive s wh o e it h e r a re u n a wa re o f t h e ir c o n d it io n o r re fu se t o b e t re a t e d (H D FPCG, 1982). No st u d ie s a re a va ila b le in Bra zil o r in La t in Am e r ic a a s a wh o le wh ic h e va lu a t e h yp e r t e n sio n m a n a ge m e n t fr o m a yp o yp u la t io n -b a sed a p p roa ch .
In 1992, a re p re se n t a t ive c ro ss- se c t io n a l st u d y wa s c a r r ie d o u t in t h e u r b a n a re a o f Pe lo t a s, Rio Gra n d e d o Su l St a t e, wit h t h e o b -je ctive s o f m e a su rin g th e p re va le n ce o f h yp e r-t e n sio n a m o n g a d u lr-t s a ge d 20 r-t o 69 ye a rs a n d e va lu a t in g t h e ro le o f a n u m b e r o f r isk fa ct o rs (Piccin i & Victora , 1994).
Fo r h yp e r t e n sive su b je ct s id e n t ifie d in t h e stu d y, in fo rm a tio n wa s co llected o n a wa ren ess o f t h e ir co n d it io n (Sa ve r e t a l., 1982), u se o f h e a lt h ca re se r vice s, co m p lia n ce wit h t re a t -m e n t , co n t ro lle d b lo o d p re ssu re, a n d so cia l rep ercu ssio n s o f th e d isea se.
A se c o n d a r y o b je c t ive wa s t o e xp lo re wh e t h e r co n t ro lle d b lo o d p re ssu re a m o n g h y-p e rt e n sive s wa s a sso cia t e d wit h se x, a ge, ra ce, so cia l cla ss, sch o o lin g, o b e sit y, sm o kin g, d is-ta n ce to h ea lth ca re p rovid er, a n d con tin u ity of ca re (Sa u n d ers, 1980; Weim b erger, 1988).
M ethodology
Th e p resen t stu d y h a d a cro ss-sectio n a l d esign wit h a p o p u la t io n b a sis. Twe n t y- five c e n su s t ra c t s in t h e u r b a n a re a o f Pe lo t a s (300,000 h a b ita n ts) were selected th ro u gh ra n d o m sa m p lin g. In e a ch t ra ct a b lo ck wa s ch o se n a t ra n
-d o m a n -d a c o r n e r wa s se le c t e -d t o st a r t t h e stu d y. Fro m th ere, o n e o u t o f every fo u r h o u se-h o ld s wa s visit e d syst e m a t ic a lly u n t il se-h a vin g co m p leted 36 h o u ses in ea ch tra ct.
Th e sa m p le size wa s ca lcu la te d to e stim a te a h yp e r t e n sio n p re va le n ce o f 15%, wit h a n a c-cep ta b le erro r o f less th a n 2%.
A st a n d a rd ize d , p re co d e d , p re t e st e d q u e s-t io n n a ire wa s give n s-t o a ll a d u ls-t s a ge d 20 s-t o 69 ye a r s re sid in g in t h e se h o u se h o ld s. It in clu d -e d in fo r m a t io n o n a g-e , s-e x, ra c -e, so c ia l c la ss, sc h o o lin g, sm o kin g, a n d d ist a n c e t o h e a lt h ca re p rovid er. Awa ren ess o f b ein g h yp erten sive wa s a lso in ve st iga t e d , a n d wh e n e ve r a p p lica b le in fo r m a t io n wa s c o lle c t e d o n t h e c h a r a c -teristics a n d co n tin u ity o f ca re.
We igh t a n d le n gt h we re m e a su re d wit h p o r t a b le e q u ip m e n t . Ob e sit y wa s d e fin e d a s a we igh t / le n gt h sq u a re d o f ove r 27.3 fo r wo m e n a n d 27.8 fo r m e n a cco rd in g to th e U S Na tio n a l He a lt h a n d Exa m in a t io n Su r ve y II (Milla r & Step h en s, 1987). Blood p ressu re was taken with a an eroid sp h ygm om an om eter at th e en d of th e in t e r vie w wit h su b je ct s in t h e sit t in g p o sit io n , righ t arm su p p orted at th e level of th e m am m a-r y lin e. Th e syst o lic p a-re ssu a-re wa s a-re co a-rd e d a t t h e b e gin n in g o f a u scu lt a t ive so u n d s a n d t h e d iastolic level wh en th ey d isap p eared (stage V). Sp h ygm o m a n o m e t e rs we re ca lib ra t e d t wice we e kly. Th e in t e r vie we rs we re se n io r m e d ica l st u d e n t s wh o we re t ra in e d a n d su b je ct e d t o sta n d a rd iza tio n sessio n s.
Five p ercen t of th e h ou seh old s were revisit-ed to ch eck wh eth er th e in terview h a d a ctu a lly b een ca rried o u t a n d to verify th e rep ea ta b ility of th e d a ta . Th e field work wa s ca rried ou t fro m Ma rch th ro u gh Ju n e 1992.
Dia gn o stic crite ria fo r h yp e rte n sio n we re a syst o lic le ve l o f 160 m m H g o r h igh e r a n d / o r a d ia st o lic p re ssu re o f 95 m m H g o r h igh e r (Co s-ta ,1983; HDFPCG, 1982; MC, 1980; Pa rty, 1985). Pa tien ts o n a n ti-h yp erten sive m ed ica tio n were a lso in c lu d e d , re ga rd le ss o f t h e ir b lo o d p re s-su re levels.
Hyp e r t e n sio n wa s co n sid e re d t o b e u n d e r co n tro l wh en ever b lo o d p ressu re wa s less th a n o r eq u a l to 160/ 90 m m H g.
A wid e ly u se d cla ssifica t io n fo r so cia l cla ss in m a rket resea rch in Bra zil wa s a d op ted , ra n k-in g fa m ilie s a cco rd k-in g t o h o u se h o ld p o sse s-sion s (Lom b ard i et al., 1988; Bron fm an & Tu irán , 1984).
Results
A t o t a l o f 1834 in d ivid u a ls a ge d 20 t o 69 ye a rs we re id e n t ifie d in t h e 900 h o u se h o ld s visit e d . Of th ese, 1657 (90.3%) were su ccessfu lly exa m -in ed . Distrib u tio n b y sex, sk-in co lo r, a n d a ge is sh own in Ta b le 1. Th e re m a in in g 9.7% we re e i-t h e r re fu sa ls o r in d ivid u a ls wh o c o u ld n o i-t b e fo u n d a t h o m e a fter th ree sep a ra te a ttem p ts.
Pre va le n c e o f h yp e r t e n sio n wa s 19.8%, o r 328 su b je ct s, o f wh o m 68% ign o re d t h e ir co n -d it io n a n -d 32% we re a wa re o f t h e ir -d ia gn o sis. Dia gn o st ic crit e ria a n d d ist rib u t io n t h e re o f in t h e sa m p le a re sh own in Ta b le 2. Ch a ra ct e r is-t ic s o f is-t h e h yp e r is-t e n sive s in is-t e r m s o f se x, a ge , a n d ra ce a re sh own in Ta b le 3.
Ta b le 4 sh ows th a t a sm a ll p rop ortion of th e su b je c t s b e lo n ge d t o h igh e r so c io e c o n o m ic stra ta , wh ile m o st b elo n ged to u n d erp rivileged st ra t a . Re ga rd in g sc h o o lin g, 20% we re illit e r -a t e -a n d o n ly 10% h -a d c o m p le t e d se c o n d -a r y sch ool.
Figu re 1 sh ows th a t two-th ird s of th e h yp er-t e n sive s we re a wa re o f er-t h e ir ser-t a er-t u s a n d er-t h a er-t m o re t h a n h a lf we re t a kin g a n t ih yp e r t e n sive m e d ica t io n , b u t t h a t o n ly o n e - t h ird h a d t h e ir b lo o d p ressu re u n d er co n tro l.
An t ih yp e r t e n sive m e d ic a t io n wa s b e in g p re scrib e d fo r 62% o f th e h yp e rte n sive s. So m e 81% we re o n d ie t re st r ic t io n s, a n d 57% h a d b een a d vised to lo se weigh t.
Th e followin g risk fa ctors for ca rd iova scu la r d ise a se s we re st u d ie d : p a t e r n a l a n d m a t e r n a l h isto ry o f h yp erten sio n , sm o kin g, a lco h o l co n -su m p t io n , a d d it io n a l u se o f sa lt o n c o o ke d fo o d , o b e sity, a n d se d e n ta r y life style. Ob e sity, a lco h o l co n su m p t io n , a n d se d e n t a r y life st yle h a d h igh freq u en cies a m o n g th e h yp erten sives ( Ta b le 5). Howe ve r, t h e se risk fa ct o rs we re n o t co m m o n ly a d d re sse d b y t h e a t t e n d in g p h ysicia n s. Of th e h yp erten sive p a tien ts u n d er m ed ic a l c a re, a b o u t 92% h a d b e e n a d vise d t o re -d u c e sa lt in t a ke a n -d 81% t o e a t le ss fa t . St ill, we igh t c o n t r o l h a d o n ly b e e n re c o m m e n d e d fo r 57% o f t h e p a t ie n t s a n d p h ysic a l e xe rc ise fo r 42%. Am o n g t h e sm o ke r s, 34% h a d b e e n a d vise d to q u it a n d 37% to re d u ce ; th u s, a b o u t 30% o f t h e sm o ke r s h a d re ce ive d n o a d vice a t a ll ( Ta b le 6).
Eva lu a tio n o f ta rget o rga n s wa s ch ecked b y a skin g p a tien ts wh eth er th ey h a d d o n e th e fo l-lowin g t e st s: e le c t r o c a rd io gra m , h e a r t X- ra y, fu n d oscop y, seru m crea tin in e, a n d u rea . Figu re 2 sh ows t h a t fu n d o sco p y, a sim p le a n d u se fu l e xa m , h a d b e e n p e r fo rm e d o n o n ly 46% o f th e p a tien ts.
Asso c ia t io n s we re so u gh t b e t we e n c o n -t ro lle d b lo o d p re ssu re a n d -t h e p a -t ie n -t s’ se x,
Tab le 1
Pro p o rtio n o f sub je c ts stud ie d ac c o rd ing to se x, skin c o lo r, and ag e .
Pe lo tas,Brazil, 1992.
Variable Proportion of the sample (%)
Sex
Fe male s 56.5
Male s 43.5
Skin color
White 81.4
Blac k o r mixe d 18.6
Age in Years
20 – 29 24.3
30 – 39 28.3
40 – 49 19.4
50 – 59 17.2
60 – 69 10.8
Tab le 2
Numb e r and p ro p o rtio n o f hyp e rte nsive sub je c ts ac c o rd ing to d iag no stic inc lusio n
c rite rio n. Pe lo tas,Brazil, 1992.
Inclusion criteria n %
Diasto lic hyp e rte nsio n o nly (95 mmHg ) 116 36
Systo lic hip e rte nsio n o nly (160 mmHg ) 18 5
Systo lic and d iasto lic hyp e rte nsio n 91 27
No rmal b lo o d p re ssure und e r re g ular 103 32 antihyp e rte nsive tre atme nt
To tal 328 100
Tab le 3
Distrib utio n o f hyp e rte nsive sub je c ts ac c o rd ing to se x, ag e , and skin c o lo r.
Pe lo tas, Brazil, 1992.
Characteristic n %
Sex
Male s 131 40
Fe male s 197 60
Skin color
White 246 75
Blac k o r mixe d 82 25
Age in Years
20 – 29 9 3
30 – 39 42 13
40 – 49 89 27
50 – 59 105 32
60 – 69 83 25
a ge, sm okin g, d ista n ce from clin ic, a n d con tin -u ed ca re by th e sa m e p h ysicia n . On ly th e la tter sh owed a sign ifica n t a sso cia tio n (p = 0.05): n o t h a vin g co n t in u e d ca re e n t a ile d a re la t ive r isk o f 1.35 (CI 95% = 1.02- 1.71) fo r u n c o n t r o lle d h yp erten sion .
In fo r m a t io n wa s ga t h e re d o n t h e so cia l re p e rcu ssio n s o f h yp e r t e n sio n in t h is sa m p le. Th e re su lt s we re st r ikin g, e sp e cia lly re ga rd in g a b se n t e e ism (12%), re d u ct io n o f wo rk lo a d (21%), a n d e a rly re t ire m e n t d u e t o h yp e r t e n -sio n (6%) ( Ta b le 7).
Discussion
Th is st u d y’s c ro ss- se c t io n a l d e sign ga ve it a n u m b e r o f a d va n t a ge s, i.e., it wa s p o p u la t io n -b a se d , low- c o st , a n d q u ic k t o p e r fo r m . Th e p ro p o rtio n o f lo sses a n d refu sa ls wa s less th a n 10% a n d t h e m e a su re m e n t s we re p e r fo r m e d with a sta n d a rd ize d p ro ce d u re. In te r-o b se r ve r va ria b ility wa s ch ecked regu la rly.
Fu r t h e r re su lt s o f t h is st u d y (Piccin i & Vic-to ra , 1994) sh owed th a t th e fo llowin g va ria b les we re sign ific a n t ly a sso c ia t e d wit h h yp e r t e n -sio n a ft e r a d ju st m e n t fo r c o n fo u n d in g va r ia b les: b lia ck skin co lo r, ia d via n ced ia ge, low ed u -ca tio n a l level, p a tern a l a n d m a tern a l h isto ry o f h yp e rte n sio n , u se o f a d d itio n a l sa lt o n co o ke d fo o d s, a n d o b e sit y. Th e st ro n g a sso cia t io n b e t we e n so c ia l c la ss a n d h yp e r t e n sio n a s d is -p la yed by th e b iva ria te a n a lysis wa s red u ced in t h e m u lt iva r ia t e a n a lysis a ft e r a d ju st m e n t fo r a ge, se x, a n d skin co lo r. Th e p re se n t a rticle fo -c u se s o n h yp e r t e n sive in d ivid u a ls a n d t h e ir m a n a gem en t.
Se ve n t y p e r ce n t o f t h e h yp e rt e n sive s we re b e t we e n 30 a n d 59 ye a r s o f a ge , a h igh ly p r o d u ctive p erio d o f life. On efo u rth h a d b een a b -se n t fr o m wo r k a t le a st o n c e in t h e p re vio u s ye a r b e c a u se o f t h e ir c o n d it io n . Eve n m o re st r ikin g wa s t h e fa c t t h a t a t h ird h a d re d u c e d th eir work loa d a n d 10% h a d gon e in to ea rly ret ire m e n ret . Th is c o n fir m s ret h e m a jo r so c io e c o -n o m ic im p a ct o f h yp erte-n sio -n .
Wit h t h e e xce p t io n o f t h e u se o f a d d it io n a l sa lt on cooked food , th e oth er r isk fa ctors stu d -ie d we re p re se n t in a t h ird t o a h a lf o f t h e h y-p e r t e n sive s in o u r sa m y-p le . Exc e y-p t fo r fa m ily h ist o r y o f h yp e r t e n sio n , a ll o t h e r r isk fa c t o r s st u d ie d ca n b e m o d ifie d b y m e d ica l a d vice. It is su rp risin g t h a t p re ve n t ive m e a su re s su ch a s e xe rcise, lo sin g we igh t , a n d st o p p in g sm o kin g were a p p roa ch ed with on ly a b ou t 50% or fewer o f th e p a tien ts.
Fu n d o sc o p y h a d b e e n c a r r ie d o u t in le ss t h a n h a lf o f p a t ie n t s in clin ica l ca re fo r h yp e r-Fig ure 1
Distrib utio n o f 328 hyp e rte nsive s ac c o rd ing to aware ne ss o f the p ro b le m,
to use o f me d ic ine s and to b lo o d p re ssure c o ntro l. Pe lo tas, Brazil, 1992.
0 50 100 150 200 250 300 350
to tal numb e r o f hype rte nsive s aware o f b e ing
hype rte nsive taking me dicine s
fo r hipe rte nsio n b lo o d pre ssure
unde r co ntro l
31%
62%
73%
100%
Tab le 5
Distrib utio n o f risk fac to rs amo ng hyp e rte nsive sub je c ts. Pe lo tas, Brazil, 1992.
Risk factor n %
Se d e ntary life style 220 67
O b e sity 181 55
Alc o ho l use 140 43
Mate rnal histo ry o f hyp e rte nsio n 142 43
Smo king 93 28
Pate rnal histo ry o f hyp e rte nsio n 85 26
Use o f ad d itio nal salt o n c o o ke d fo o d 16 5 Tab le 4
Distrib utio n o f hyp e rte nsio n ac c o rd ing to so c ial c lass and sc ho o ling .
Pe lo tas, Brazil, 1992
Hypertension %
Social class according ABIPEM E
A (hig he st) and B 7
C 18
D 39
E (lo we st) 36
Schooling in Years
Ze ro 20
1 – 4 29
5 – 7 27
8 – 10 10
11 – 17 14
ten sio n ; th is is a rem a rka b ly low figu re co n sid -erin g th a t th is test is p a rt of th e a d eq u a te p h ys-ica l e va lu a tio n o f th e d ise a se. Oth e r te sts we re p e r fo r m e d m o re o ft e n , in c lu d in g X- ra ys a n d ECG.
Two -th ird s o f th e h yp erten sives were a wa re o f th eir co n d itio n a n d 60% were ta kin g a n tih y-p erten sive m ed ica tion , b u t on ly on e-th ird were co n t ro lle d . Th e se re su lt s a re a b ove t h e “la w o f h a lve s” co m m o n ly m e n tio n e d in th e lite ra tu re (Pe d o e, 1982), n a m e ly, t h a t o n e h a lf o f h yp e r-t e n sive s kn ow r-t h e ir c o n d ir-t io n , o n e h a lf r-t a ke m e d ica t io n , a n d o n e h a lf o f t h e la t t e r a re co n -trolled .
A fin d in g wh ich d e se r ve s sp e cia l a t t e n t io n is t h e a sso cia t io n b e t w e e n co n t in u e d clin ica l ca re b y t h e sa m e p h ysicia n a n d co n t ro lle d h y-p erten sio n . Th is is y-p a rticu la rly releva n t fo r d e-velop in g cou n tries, wh ere govern m en t services o ft e n fa il t o p rovid e p e rso n a lize d , co n t in u o u s ca re a n d sh iftin g a rou n d from on e p h ysicia n to a n o th er is o ften th e ru le.
In su m m a r y, t h e p re se n t st u d y d o cu m e n t-e d t h t-e rt-e lt-e va n c t-e o f h yp t-e r t t-e n sio n a s a p u b lic h e a lt h p ro b le m wit h m a rke d so cia l re p e rcu s-sio n s in a n u r b a n a re a fro m a le ss d e ve lo p e d co u n try. Im p o rta n t sh o rtco m in gs we re d e te cted rega rd in g th e clin ica l exa m in a tion of h yp er ten sives, m a n a gem en t o f risk fa cto rs, a n d co n -tro l o f b lo o d p ressu re levels.
Th e p re se n t d a t a sh o u ld st im u la t e h e a lt h c a re p r ovid e r s a n d p o lic y- m a ke r s t o im p r ove screen in g a n d con tin u ed ca re to th ese p a tien ts. Su rveys su ch a s th e p resen t on e, ca rried ou t over a sh o rt tim e sp a n a n d in vo lvin g low co sts, m a y p rove to b e e xtre m e ly u se fu l fo r a sse ssin g th e p reva len ce o f h yp erten sio n a n d th e q u a lity o f its m a n a gem en t o n a co m m u n ity b a sis.
Tab le 7
So c ial re p e rc ussio ns o f hyp e rte nsio n. Pe lo tas, Brazil, 1992
Repercussions n %*
Wo rk lo ad re d uc tio n 68 21
Any ab se nc e fro m wo rk last ye ar 38 12
Chang e o f wo rk style 16 5
Early re tire me nt 18 6
Ho sp italizatio n last ye ar 13 4
* n = 328 Tab le 6
Clinic al ad vic e to hyp e rte nsive sub je c ts ab o ut manag e me nt o f risk fac to rs.
Pe lo tas, Brazil, 1992.
Advice given %*
Re d uc e salt intake 92
Re d uc e fat intake 81
Lo se we ig ht 57
Do p hysic al e xe rc ise 42
Sto p smo king 37**
Re d uc e smo king 34**
* Hyp e rte nsive sub je c ts who d id no t se e k c linic al c are we re inc lud e d . ** Analyse s re stric te d to smo ke rs.
Fig ure 2
Distrib utio n o f hyp e rte nsive s ac c o rd ing to se le c te d d iag no stic e xaminatio ns.
Pe lo tas, Brazil, 1992.
0 20 40 60 80 100
b lo o d te sts fund o sco p y
card iac x-ray e le ctro card io g ram
74%
48%
46%
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