CHARACTERIZATION OF DIABETICS AND HYPERTENSIVE PEOPLE MONITORED
BY THE COMPUTERIZED SYSTEM OF REGISTRATION AND MONITORING OF
HYPERTENSIVE AND DIABETICS
CARACTERIZAÇÃO DOS DIABÉTICOS E HIPERTENSOS ACOMPANHADOS PELO SISTEMA
INFORMATIZADO DE CADASTRAMENTO E ACOMPANHAMENTO DE HIPERTENSOS E
DIABÉTICOS
CARACTERIZACIÓN DE LOS DIABÉTICOS E HIPERTENSOS SEGUIDOS POR EL SISTEMA INFORMATIZADO DE CATASTRO Y SEGUIMIENTO DE HIPERTENSOS Y DIABÉTICOS
Isabelle Katherinne Fernandes Costa1, Manuela Pinto Tibúrcio2, Gabriela de Sousa Martins Melo3, Jussara de
Paiva Nunes4, Maria Eliane Mendes de Freitas Néo5, Gilson de Vasconcelos Torres6
ABSTRACT
Objective: to characterize the sociodemographic and health profiles of users monitored by the Sis-HIPERDIA
Program. Method: it is a descriptive study, of cross-sectional cohort, with quantitative approach that focused users monitored by the Sis-HIPERDIA Program, System of Registration and Monitoring of Hypertensive and Diabetics in a Family Health Unit - Unidade de Saúde da Família (USF) in the city of Natal-RN, Brazil, through secondary data. Results: of 326 patients, 82.8% were hypertensive, 33.7% were diabetics, and 18.7% had hypertension and diabetes at the same time. Among the users with hypertension and/or diabetes, the majority were female, aged greater than or equal to 60 years old, with incomplete high school, they were living with a partner and children. Conclusion: it is important to highlight the importance of knowing the characteristics of users who attend the health services, since this is the first step to track strategies that improve the care and reduce morbidity and mortality. Descriptors: Hypertension; Diabetes Mellitus; Primary Health Care; Health Profile.
RESUMO
Objetivo: caracterizar os perfis sociodemográfico e de saúde dos usuários acompanhados pelo Programa
Sis-HIPERDIA. Método: estudo descritivo, transversal, quantitativo, realizado com a população de 326 pacientes acompanhados e cadastrados no Sistema Informatizado de Cadastramento e Acompanhamento de Hipertensos e Diabéticos/Sis-HIPERDIA de uma Unidade de Saúde da Família de Natal/RN/Brasil, por meio de dados secundários. Resultados: dos 326 pacientes, 82,8% eram hipertensos, 33,7% eram diabéticos, e 18,7% apresentavam hipertensão e diabetes ao mesmo tempo. Dentre os usuários com hipertensão e/ou diabetes, a maioria era do sexo feminino, com idade maior ou igual a 60 anos, ensino fundamental incompleto e viviam com o companheiro e filhos. Conclusão: é relevante destacar a importância de se conhecer as características dos usuários que frequentam os serviços de saúde, pois este é o primeiro passo para se traçar estratégias que melhorem o atendimento e reduza a morbimortalidade. Descritores: Hipertensão; Diabetes Mellitus; Atenção Primária à Saúde; Perfil de Saúde.
RESUMEN
Objetivo: caracterizar el perfil socio-demográfico y sanitario de los usuarios seguidos por el Programa
Sis-HIPERDIA. Método: estudio descriptivo, transversal, cuantitativo, realizado en un universo de 326 pacientes acompañantes y registrados en el Sistema Informatizado de Catastro y Seguimiento de Hipertensos y Diabéticos/Sis-HIPERDIA de una Unidad de Sanidad de la Familia de Natal/RN/Brasil por medio de datos secundarios. Resultados: de los 326 pacientes, el 82,8% eran hipertensos, 33,7% eran diabéticos, y el 18,7% presentaban hipertensión y diabetes. Entre los usuarios con hipertensión o diabetes la mayoría era del sexo femenino, con edad mayor o igual a 60 años, enseñanza primaria incompleta y vivían con compañero e hijos.
Conclusión: es relevante destacar la importancia de conocer las características de los usuarios que frecuentan
los servicios sanitarios, puesto que este sería el primer paso para diseñar estrategias que mejoren la atención y reduzca la morbi-mortalidad. Descriptores: Hipertensión; Diabetes Mellitus; Atención Primaria a la Salud; Perfil de Salud.
1Nurse. Doutorate’s Student from Post-Graduate Program in Nursing, from Universidade Federal do Rio Grande do Norte/UFRN. Member of the
Research Group: Incubator of Nursing Procedures. Natal (RN), Brazil. E-mail: isabellekfc@yahoo.com.br; 2Nurse. Master’s Student from
Post-Graduate Program in Nursing, from Universidade Federal do Rio Grande do Norte/UFRN. Member of the Research Group: Incubator of Nursing Procedures. Natal (RN), Brazil. E-mail: manuelapintoo@yahoo.com.br; 3Master’s Student from Post-Graduate Program in Nursing, from Universidade
Federal do Rio Grande do Norte/UFRN. Member of the Research Group: Incubator of Nursing Procedures. Natal (RN), Brazil. E-mail:
gabrielasmm@hotmail.com; 4Nurse. Master in Nursing/UFRN. Natal (RN), Brazil. E-mail: jussarapaiva1@hotmail.com; 5Nursing from Family Health
Strategy - Estratégia Saúde da Família/SMS. Natal (RN), Brazil. E-mail: eliane.neo@hotmail.com; 6Nurse. Post-PHD in Nursing. Titular Professor
from the Nursing Department and of the Post-Graduate Program in Nursing /UFRN. Researcher of CNPq PQ2. Coordinator of the Research Group: Incubator of Nursing Procedures. Natal (RN), Brazil. E-mail: gilsonvtorres@hotmail.com
The cardiovascular diseases are the main cause of death in Brazil. Of the 1.115.695 deceases reported in 2009 from all causes, 72.4% were due to chronic non-communicable diseases (NCDs). The most frequent causes of death in 2009 were the heart diseases (31.3%), cancer (16.2%), the respiratory diseases (5.8%) and diabetes (5.2%). Jointly, these four diseases account for 80.5% of total of deceases by NCDs.1
Even if not lethal, the cardiovascular diseases may lead to the physical disability,
with prolonged hospital stay and,
consequently, generating high social and hospital costs, as well as losses in life quality.2-3These diseases have as main feature
the multi-causality, that is to say, several risk factors increase the likelihood of its occurrence. According to the current guidelines, arterial hypertension and diabetes mellitus represent two of the greatest risk factors, contributing decisively to the worsening of this scenario at the national level.4
In this sense, some priorities were outlined by the reorganization plan of care for patients with Systemic Arterial Hypertension (SAH) and diabetes mellitus (DM), implemented by the Brazilian Ministry of Health in 2001, with emphasis on the network of Primary Health
Care (PHC). The plan aimed at the
reorganization of health services, in order to offer qualified and continued attention to the carriers of DM and / or SAH, by developing of clinical protocols and training of health professionals; the insurance the free distribution of antihypertensive medications, oral hypoglycemic agents and insulin of intermediate action; and the creation of a Computerized System of Registration and Monitoring of Hypertensive and Diabetics called Sis-HIPERDIA, better known as HIPERDIA.5
The HIPERDIA system was developed with the objective to allow the monitoring of patients registered and treated in the outpatient network of the Brazilian Unified Health System - Sistema Único de Saúde (SUS), generate information for acquisition, dispensing and distribution of prescribed medicinal drugs in the medium term, on a regular and systematic manner, besides to provide essential epidemiological data for the definition of actions and policies of prevention of SAH and DM in the population in general. This information flow occurs from the filling the Registration Form of hypertensive patient
and / or diabetic by the health professionals. 6-7
The interest in researching the thematic arose during the Supervised Internship I: the process of work of the nurse in the Primary Health Care, which is mandatory for students of 8th period of nursing graduate course from the Universidade Federal do Rio Grande do
Norte and offers an opportunity for students
to undertake the role that the nurse plays in the practice of health services. In the course of the internship, students and preceptors found that the Basic Health Units are unaware on the profile of their users and not follow the changes arising from demand met, which ends up affecting negatively in effective planning of measures of health education, prevention and control of complications. In this sense, the study will contribute in providing
epidemiological data that constitute
themselves in relevant parameters for the development of actions and policies of prevention of hypertension and diabetes in the population.
In this context, the objective of this study is characterizing the sociodemographic and health profiles of users monitored by the Sis-HIPERDIA Program.
It is a descriptive study, of cross-sectional cohort, with quantitative approach that focused users monitored by the Sis-HIPERDIA
Program, System of Registration and
Monitoring of Hypertensive and Diabetics in a Family Health Unit - Unidade de Saúde da
Família (USF) in the city of Natal-RN, Brazil.
The Family Health Unit in question is located in the East Administrative Region, in the city of Natal-RN, Brazil, it is composed of two areas, and each one is subdivided into five micro-areas. The team work seeks to promote health, prevent diseases, avoid unnecessary hospitalizations and improve life quality. The Sis-HIPERDIA Program exists in that Unit since the year of 2004.
The study population was composed of 326 patients monitored by the Sis-HIPERDIA Program from the USF, with 159 patients from one area and 167 from the another one. Since it is a demand research, we analyzed all of the forms from diabetic and hypertensive users enrolled in the Sis-HIPERDIA of the USF in the period of data collection (January to May 2009). Thus, no exclusion criteria were adopted.
For data collection, we used secondary data were collected from the registration
METHOD
INTRODUCTION
forms of the Sis-HIPERDIA, from Brazilian Ministry of Health8, for characterization of the
researched population. Data were collected at USF, including all registration forms of hypertensive and diabetic people monitored by the Unit during the period of data collection.
The variables studied were: gender, age, breed, schooling, marital status / family, Body Mass Index (BMI), risk factors, complications and medications used.
For categorization of the variables, we used that one already existing in the registration form of the Sis-HIPERDIA.8 The
Body Mass Index (BMI) was classified in normal (BMI ≥ 18,5Kg/m2 e < 24,9Kg/m2), overweight
(BMI ≥ 25,0Kg/m2 and < 29,9Kg/m2),
overweight class I (BMI ≥ 30,0Kg/m2 and <
34,9Kg/m2), overweight class II (BMI ≥
35,0Kg/m2 and < 39,9Kg/m2) and overweight
class III (BMI ≥ 40,0Kg/m2). The risk factors
were: cardiovascular family history, smoking
(consumption ≥ 1 cigarette per day),
sedentarism (less than 30 minutes of exercise, three times a week and does not do physical effort with weight at home or at work) and overweight / obesity. The complications studied were: acute myocardial infarction, or another coronary arterial disease, stroke, and diabetic foot, amputation by diabetes and kidney disease.
Other categorizations were developed in order to better serve the purpose of this study and facilitate our understanding. Age was categorized into age groups, with up to 59 years and equal to or greater than 60 years, the BMI was grouped into overweight / obesity (BMI ≥ 25kg/m2).
The study was circumscribed by fulfillment of the ethical principles and it is in accordance with the Resolution 196/96 which
deals with research involving human
subjects.9The study has obtained a favorable
opinion of the direction of the researched institution. It is noteworthy to note that the information used comes from public data contained in the database of the Sis-HIPERDIA program, and the anonymity of users was safeguarded.
The data were organized using Microsoft Office Excel 2007 and were analyzed after being encoded, using the statistical program Statistical Package For The Social Sciences (SPSS) 20.0, being coded, tabulated and presented in tables and figures with their respective percentage distributions. For statistical analysis, we used the Chi-Square
test, by adopting as statistical significance level ρ-value less than or equal to 0.05.
We surveyed 326 patients, of whom 68.7% are women, more than half (58.6%) had 60 years old or more; with minimum age of 14 years and maximum with 88 years, resulting in an average of 60.1 ± 13.5. Of the patients enrolled in the Sis-HIPERDIA, 61 (18.7%) were both hypertensives and diabetics. So, 270 (82.8%) were hypertensives and 110 (33.7%) were diabetics, of which 37 (33.6 %) had type 1 diabetes and, 73 (66.4%) showed type 2 diabetes.
Population surveys in Brazilian cities over the past 20 years showed a prevalence of SAH above 30.0%. By considering for the diagnosis of this condition BP values ≥ 140/90 mmHg, studies have found prevalence rates between 22.3% and 43.9% (average 32.5%), with more than 50.0% between 60 and 69 years and, 75.0% over 70 years old, which shows us a direct and linear relation of the blood pressure with age.10-11
As for diabetes mellitus, one research conducted in the Brazilian State of São Paulo with data collected through home visits showed the prevalence of the disease in 16.6% of users; and in terms of age, the prevalence of DM was 4.7% in the age group from 30 to 39 years and, 29.0% from 70 to 79 years old.12
With regard to the increasing elevation of prevalence of SAH and DM with the increase of the age, this study corroborates the abovementioned, in which the 191 users aged greater than or equal to 60 years old (82.2%) had SAH and, 37.7 % had DM. Added to this the considerable growth of the elderly population in the country. Thus, the improvement in primary care becomes essential, in order to meet the demands of the community, in accordance with the principles of the SUS.13
Table 1 shows the distribution of sociodemographic characteristics of users monitored by the Sis-HIPERDIA Program of the USF, according to the base pathology. Among users with SAH, most are female (69.6%); 58.1% are aged greater than or equal to 60 years old; 42.2% reported being white; 36.3% had incomplete elementary school and, 45.9% reported living with a partner and children.
Considering the data of patients with diabetes, there were more women, with 63.6%, and the predominant age group was the elderly (65.5%) and they were living with a partner and children (40.9%). As for skin color, 36.4% said they were white and 33.6%
reported being mixed. There was a distribution among the categorizations of schooling, highlighting those ones who had
incomplete elementary school with 28.2% of the sample.
Table 1. Sociodemographic characterization of the users monitored by the Sis-HIPERDIA
Program of the USF, according to the base pathology. Natal-RN, Brazil, 2009.
Sociodemographic characterization SAH Diabetes SAH and diabetes
n % n % n % Gender Female 188 69,6 70 63,6 39 63,9 Male 82 30,4 40 36,4 22 36,1 Age group Up to 59 years old 113 41,9 38 34,5 20 32,8 ≥ 60 years old 157 58,1 72 65,5 41 67,2 Breed White 114 42,2 40 36,4 25 41,0 Mixed 73 27,0 37 33,6 20 32,8 Black 46 17,0 15 13,6 8 13,1 Yellow 10 3,7 3 2,7 1 1,6 Indigenous 17 6,3 6 5,5 4 6,6 Unanswered 10 3,7 9 8,2 3 4,9 Schooling Level Illiterate 54 20,0 26 23,6 17 27,9 Just literate 39 14,4 20 18,2 9 14,8
Incomplete Elementary School 98 36,3 31 28,2 18 29,5 Complete Elementary School 17 6,3 5 4,5 4 6,6 Incomplete High School 15 5,6 7 6,4 2 3,3 Complete High School 37 13,7 14 12,7 9 14,8 Complete College Degree 2 0,7 5 4,5 1 1,6
Unanswered 8 3,0 2 1,8 1 1,6
Marital Status
Partner and chidren 124 45,9 45 40,9 26 42,6 People with blood ties 73 27,0 36 32,7 21 34,4
Alone 20 7,4 5 4,5 1 1,6
Partner, children and other family
members 15 5,6 7 6,4 6 9,8
Partner and family members 11 4,1 4 3,6 2 3,3
Partner 10 3,7 6 5,5 2 3,3
Unanswered 17 6,3 7 6,4 3 4,9
Total 270 100,0 110 100,0 61 100,0
In the studied sample there was a predominance of females, corroborating other studies on the profile of users monitored by the Sis-HIPERDIA program, which is justified by the superiority of female in the medical charts, since women are diagnosed in greater proportion, by seeking more often health services and they are more inclined to the self-care. 14-17This fact demonstrates the
importance of encouraging a greater
participation and follow-up by the men in health systems, conducting an active search for this audience and stimulating it for adhering to the measures to the promotion and protection of the health.18
Other important sociodemographic
characteristics that deserve attention are marital status and schooling. This last one directly influences on the self-care and adherence to the treatment, while the another one demonstrates a close relationship of successful in therapeutic regimen with the family support, since the family as caregiver of patient affected by SAH and / or DM helps in controlling of the blood pressure and glycemic rates, respectively.
In this study, the majority had low schooling level, ranging from illiterate to the incomplete elementary school, this is a result that was also prevalent in other studies.6,12 In
contrast, there was a predominance of users who lived with partners and children.
The group of individuals affected, concomitantly, by SAH and DM was composed of female users (63.9%); there was a predominance of the age group greater than or equal to 60 years old (67.2%); they cited their breeds as blacks (41.0%); regarding the schooling level, there was an equivalence between the group that concluded the elementary school, with 29.5%, and those who could not read and / write, with 27.9% of enrolled users and, 42.6% of them reported that were living with a partner and children.
A study conducted in Rio de Janeiro (Brazil) showed that 65.8% of those who were surveyed had SAH and only 11.0%, had diabetes, but 23.3% had these two pathologies at the same time, which demonstrates the potential of their association and the importance of management of both in a same patient.13
Figure 1 shows the risk factors, the most common was the overweight / obesity (74.8%), followed by sedentarism (62.6%).
Similar results to those aforementioned were found in other studies.6,14,19
Figure 1. Risk factors of patients monitored by the Sis-HIPERDIA Program of the
USF. Natal-RN, Brazil, 2009.
SAH and diabetes mellitus, jointly with smoking, obesity and sedentarism are the higher prevalence risk factors known and controllable of the cerebrovascular diseases and the ischemic heart diseases.17 Associated
with this, genetic predisposition to the cardiovascular and cerebrovascular diseases tends to worsen the situation of these people who have unhealthy lifestyle.10
The population education is the best way for producing changes in lifestyle, and it is considered an intervention of moderate cost when compared to the high budgets of the treatments with medicinal drugs and dependent on high technology. Thus, the adequate management of educational and preventive measures is essential for reducing
the prevalence observed, in order to provide higher life quality and reduction of future cardiovascular events.14,20
Among the complications arising from hypertension and diabetes, according to the register of Sis-HIPERDIA, it was found that of the study population 8.9% had other coronary arterial diseases; 8.3% Acute Myocardial Infarction (AMI); 7.4 % kidney disease; and 5.2% Cerebral Vascular Accident (CVA), which is consistent with data obtained in a survey with three health units in the South of Brazil. This reinforces the fact that vascular complications resulting from SAH produce lesions in organs such as heart, brain and kidneys.14The other complications showed
smaller percentages, as shown in Figure 2.
Figure 2. Concomitant diseases of patients monitored by the Sis-HIPERDIA program o the USF.
Natal-RN, Brazil, 2009.
Table 2 shows the distribution of risk factors and concomitant diseases of the users enrolled in the Sis-HIPERDIA by base pathology. Of the 270 hypertensive subjects, 77.8% were with overweight / obesity, the
association between SAH and body mass was significant (ρ-value 0.018); 56.3% had a family history of cardiovascular illnesses; 65.9% reported being sedentary (ρ-value 0.006); only 15.9% were smokers.
Table 2. Risk factors and concomitant diseases of the users monitored
by the Sis-HIPERDIA Program of the USF, according to the base pathology. Natal-RN, Brazil, 2009.
Risk factors and diseases SAH Diabetes
SAH and Diabetes n % n % n % Body Mass Underweight 7 2,6 6 5,4 2 3,3 Average weight 53 19,6 31 28,2 15 24,6 Overweight 210 77,8 73 66,4 44 72,1
Cardiovascular family history
No 118 43,7 50 45,5 22 36,1 Yes 152 56,3 60 54,5 39 63,9 Sedentarism No 92 34,1 46 41,8 19 31,1 Yes 178 65,9 64 58,2 42 68,9 Smoking No 227 84,1 90 81,8 48 78,7 Yes 43 15,9 20 18,2 13 21,3
Other coronary arterial diseases
No 245 90,7 99 90,0 52 85,2
Yes 25 9,3 11 10,0 9 14,8
Acute Myocardial Infarction
No 246 91,1 101 91,8 54 88,5
Yes 24 8,9 9 8,2 7 11,5
Cerebral Vascular Accident(Stroke)
No 255 94,4 101 91,8 54 88,5 Yes 15 5,6 9 8,2 7 11,5 Kidney disease No 252 93,3 102 92,7 59 96,7 Yes 18 6,7 8 7,3 2 3,3 Diabetic foot No 270 100,0 108 98,2 61 100,0 Yes 0 0,0 2 1,8 0 0,0 Amputation No 270 100,0 109 99,1 61 100,0 Yes 0 0,0 1 0,9 0 0,0 Total 270 100,0 110 100,0 61 100,0
Epidemiological studies have shown a strong association that major chronic
non-communicable diseases keep with a
considerably small group of modifiable risk factors. Among them, it should be highlighted: smoking, heavy consumption of alcohol,
overweight, hypertension,
hypercholesterolemia, poor nutrition and sedentarism.21 Given the global epidemic of
overweight and sedentary lifestyle, the regular practice of physical exercises is recommended for all individuals, including those under medical treatment, being able to reduce the risk of coronary arterial disease, stroke and mortality in general.4
Among the users enrolled with diabetes, overweight has predominated in 66.4% of them, and the association of diabetes with weight was significant (ρ-value 0.033); 54.5%
reported about a cardiovascular family history; 58.2% were sedentary and 18.2% were smokers.
Of the users enrolled with a diagnosis of SAH and DM concomitantly, stood out 72.1% with overweight; 63.9% reported having a cardiovascular family history; 68.9% admitted being sedentary and 21.3% told they were smokers. Of the complications that were questioned in the form of the Sis-HIPERDIA, 14.8% presented other heart diseases, 11.5% had AMI, 11.5% had CVA, and 3.3% reported on kidney disease.
Table 3 shows the characteristics of the therapeutic regimen of the respondents, in which most (95.7%) made use of a medicinal drug treatment, with more than half using at least one medicinal drug (36.8%) and they were taking two pills per day (20.9%).
Table 3. Therapeutic regimen of users monitored by the Sis-HIPERDIA
Program of the USF. Natal-RN, Brazil, 2009.
Therapeutic regimen n %
Type of treatment
Without medicinal drugs 14 4,3
With medicinal drugs 312 95,7
Amount of medicinal drugs in use
None 14 4,3 One 120 36,8 Two 107 32,8 Three 53 16,3 Four 14 4,3 Five 5 1,5
Isolated therapy with insulin 7 2,1
Unanswered/ unknown 6 1,8
Amount of pills per day
None 14 4,3 One 66 20,2 Two 68 20,9 Three 53 16,3 Four 51 15,6 Five 27 8,3 Six 17 5,2 Seven 6 1,8 Eight 5 1,5 Nine 3 0,9 ≥ Ten 3 0,9
Isolated therapy with insulin 7 2,1
Unanswered/ unknown 6 1,8
Total 326 100,0
The greatest number of prescribed medicinal drugs and the therapeutic scheme are associated with non-adherence, even when the drug is furnished. Therapeutic schemes involving multiple medications are often complex and require great attention, responsibility and commitment on the part of the patient, who must readapt its diet, hours and daily rhythm to meet the treatment.22
As for the most used drugs by users
enrolled in the program, the
hydrochlorothiazide (38.3%) and captopril (32.8%) were the most cited. The emphasis on the use of antihypertensive drugs is associated with a high percentage of hypertensive subjects in the research; Followed by metformin, with 19.0 %, and glibenclamide, with the 17.2%, the hypoglycemics were the most used. Only 2.8% of respondents were using injectable insulin, of these 2.0% were using insulin combined with another oral medicine drug.
The aforementioned confirms the
responsibility of the federal manager regarding the procurement and supply of medicaments selected for the treatment of SAH to municipalities (captopril 25 mg, hydrochlorothiazide 25 mg and propranolol hydrochloride 40 mg) and for DM (NPH-100 insulin, glibenclamide 5 mg and metformin 850 mg), in order to contemplate all registered users.
It is believed that the continuous supply of these drugs registered by the Brazilian Ministry of Health, through the National Program of Pharmaceutical Assistance for
Hypertension and Diabetes Mellitus, is one of the components for consolidation of the right to the health guaranteed by SUS.23-24
The use of medicinal treatment is restricted to a part of the patients, whereas
the non-pharmacological strategies are
essential to everyone. These measures are carried out by means of changes in lifestyle, which may prevent or delay the installation of SAH and DM, as well as other comorbidities.
The main changes in lifestyle that can reduce such diseases and their complications include: physical activities, healthy nutritional habits, weight control, smoking cessation, reduction of alcohol consumption and anti-stress measures. Nevertheless, behavioral changes are not easily performed, since they require discipline and patience to the achievement of outcomes. Thus, the family and the health network professionals, trained and qualified, constitute in an essential support network so that the users can reach these results.4,6
It is important to highlight the importance of knowing the characteristics of users who attend the health services, as this is the first step to track action strategies for improving the care and reduce morbidity and mortality.
It is indispensable to consider the subjectivity of each individual within an educational process, according to their experiences, knowledge, beliefs and values, as well as knowing its origin, the environment in which it lives, schooling, life habits, factors risks and complications, in order to cause not only changes in lifestyle, but also the
maintenance of these practices.25
As limitation of this study, it was noticed that some data considered mandatory by the Brazilian Ministry of Health are no longer reported in some medical charts, such as: breed, schooling, marital status and signature of the responsible by filling up the registration. The omission of such information may interfere with the final processing of the forms, negatively influencing potential studies on the epidemiological profile and disabling the monitoring and implementation of strategies which would transform the current condition of these individuals.
Among the users with hypertension and / or diabetes, the majority were female, aged greater than or equal to 60 years old, with incomplete high school; they were living with a partner and children, making use of a medicinal drug treatment and, the main risk factor was the overweight / obesity. Among the complications, the most frequent were the coronary arterial diseases.
The difference in proportion between the registers of men and women, found in this study, indicates the need of health unit for improving their registration strategies in the Sis-HIPERDIA, mainly with regard to the men, so that a higher percentage of the population can be diagnosed and have an appropriate monitoring.
The reduction of smoking, obesity, and at the same time a provision of nutritional guidance and encouragement to the regular practice of physical exercises are goals that should guide the actions for the control of hypertension and diabetes. The plan of reorganization of the Systemic Arterial Hypertension (SAH) and Diabetes Mellitus (DM), in Brazil, was an important step, but it needs for a constant evaluation to measure the impacts created to the population.
Given the epidemiological relevance of SAH and DM in Brazil, the active identifying and provision of monitoring and treatment – with medicaments or not - should be made more systematically by the health services, seeking to carry out actions for health promotion, as well as the early diagnosis for prevention of complications, reduction of morbidity and mortality, improving the life quality and decreasing costs in the health system.
1. Duncan BB, Stevens A, Iser BPM, Malta DC, Silva GA, Schmidt MI, et al. Mortalidade por doenças crônicas no Brasil: situação em 2009 e tendências de 1991 a 2009. In: Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Análise de Situação em Saúde. Saúde Brasil 2010: uma análise da
situação de saúde e de evidências
selecionadas de impacto de ações de vigilância em saúde [Internet]. Brasília: Ministério da Saúde; 2011 [updated 2012 June 17; cited 2012 June 17]:117-34. (Série G. Estatística e Informação em Saúde). Available from:
http://portal.saude.gov.br/portal/arquivos/p df/cap_5_saude_brasil_2010.pdf.
2. Malta DC, Moura L, Souza FM, Rocha FM, Fernandes FM. Doenças crônicas não-transmissíveis: mortalidade e fatores de risco no Brasil, 1990 a 2006 in Saúde Brasil 2008. Ministério da Saúde [Internet]. 2009 [cited 2011 Dec 11];337–62. Available from:
http://portal.saude.gov.br/portal/arquivos/p df/saude_brasil_2008_web_20_11.pdf.
3. Borges JWP, Pinheiro NMG, Souza ACC.
Hipertensão comunicada e hipertensão
compreendida: saberes e práticas de enfermagem em um Programa de Saúde da Família de Fortaleza, Ceará. Ciênc saúde coletiva [Internet]. 2012 [cited 2012 Apr
28];17(1):179-89. Available from:
http://www.scielosp.org/pdf/csc/v17n1/a20v 17n1.pdf.
4. Sociedade Brasileira de Cardiologia / Sociedade Brasileira de Hipertensão / Sociedade Brasileira de Nefrologia. VI Diretrizes Brasileiras de Hipertensão. Arq bras cardiol [Internet]. 2010 [updated 2012 June 17; cited 2012 June 17];95(1supl.1):1-51.
Available from:
http://publicacoes.cardiol.br/consenso/2010/ Diretriz_hipertensao_associados.pdf.
5. Chazan AC, Perez EA. Avaliação da implementação do sistema informatizado de
cadastramento e acompanhamento de
hipertensos e diabéticos (hiperdia) nos municípios do estado do Rio de Janeiro. Rev APS [Internet]. 2008 [cited 2012 May
10];11(1):10-6. Available from:
http://www.seer.ufjf.br/files/journals/3/arti cles/197/public/197-833-1-PB.pdf.
6. Ferreira CLRA, Ferreira MG. Características epidemiológicas de pacientes diabéticos da rede pública de saúde: análise a partir do sistema HiperDia. Arq bras endocrinol metab. 2009 [cited 2012 Feb 20];53(1):80-6. Available
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Sources of funding: No Conflict of interest: No
Date of first submission: 2012/07/17 Last received: 2012/10/11
Accepted: 2012/10/12 Publishing: 2012/11/01
Corresponding Address
Isabelle Katherinne Fernandes Costa Rua do Motor, 39 ― Praia do Meio CEP: 59010-090 ― Natal (RN), Brazil
