Original Article
Rev. Latino-Am. Enfermagem 2014 July-Aug.;22(4):547-53 DOI: 10.1590/0104-1169.3345.2450
www.eerp.usp.br/rlae
Arterial Hypertension and other risk factors associated with cardiovascular diseases among adults1
Cremilde Aparecida Trindade Radovanovic2 Lucimary Afonso dos Santos3 Maria Dalva de Barros Carvalho4 Sonia Silva Marcon5
Objective: to identify the prevalence of arterial hypertension and its association with cardiovascular risk factors among adults. Method: cross-sectional, population-based, descriptive study conducted with 408 adult individuals. Data were collected through a questionnaire and measurements of weight, height and waist circumference. Person’s Chi-square and multiple logistic regression were used in the data analysis. Results: 23.03% of the individuals reported hypertension with a higher prevalence among women. Odds Ratio indicated that smoking, body mass index, waist circumference, diabetes mellitus and dyslipidemia were positively associated with arterial hypertension. Conclusion: high self-reported hypertension and its association with other cardiovascular risk factors such as diabetes, obesity and dyslipidemia show the need for specific nursing interventions and the implementation of protocols focused on minimizing complications arising from hypertension, as well as to prevent the emergence of other cardiovascular diseases. Descriptors: Hypertension; Cardiovascular Diseases; Risk Factors; Adults.
1
Paper extracted from doctoral dissertation “Factors and cardiovascular risk behaviors in adults resident in Paiçandu – Paraná – effects of an intervention in health”, presented to Universidade Estadual de Maringá, Maringá, PR, Brazil. Supported by Fundação Araucária, process # 19510/2010, Brazil.
2
PhD, Adjunct Profesor, Universidade Estadual de Maringá, Maringá, PR, Brazil.
3
PhD, Adjunct Professor, Universidade Estadual do Paraná, Paranavaí, PR, Brazil.
4
PhD, Associate Professor, Universidade Estadual de Maringá, Maringá, PR, Brazil.
5
PhD, Full Professor, Universidade Estadual de Maringá, Maringá, PR, Brazil.
Corresponding Author: Cremilde Aparecida Trindade Radovanovic Rua Jaspe, 256 Jardim Brasil CEP: 87083-276, Maringá, PR, Brasil E-mail:
[email protected]
Copyright © 2014 Revista Latino-Americana de Enfermagem This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC). This license lets others distribute, remix, tweak, and build upon your work non-commercially, and although their new works must also acknowledge you and be non-commercial, they don’t have to license their derivative works on the same terms.
548
Rev. Latino-Am. Enfermagem 2014 July-Aug.;22(4):547-53.
Introduction
The individuals were selected in a systematic random sample in which the streets, blocks and
Cardiovascular diseases (CVD) are currently the
households were randomly drawn. Systematically and
leading cause of deaths worldwide. These diseases
with a predefined interval, one individual living in the
accounted for more than 17 million deaths in 2008,
fourth household on the right side of the street was
three million of which occurred before the age of
addressed. When no individuals within the selected age
60. Most could have been avoided. The World Health
group lived in the house, we moved to the subsequent
Organization estimates that around 23.6 million people
house in which only one individual was interviewed.
will die of cardiovascular diseases in 2030(1).
Data were collected from September 2010 to
Among the CVD, systemic arterial hypertension
February 2011 through interviews and measurements
(SAH) is an important risk factor for cardiac and
of weight, height, and waist circumference (WC).
cerebrovascular complications(1). It is considered a
The instrument used for the interviews is part of an
public health problem around the world. In 2000, the
instrument adopted in a household survey addressing
prevalence of SAH in the world population was 25%
behavioral risk and morbidity of non-communicable
and the estimate for 2025 is 29%(2). The prevalence
diseases(7). This questionnaire was previously tested
of hypertension verified in studies conducted in Brazil
in a pilot-study with 20 individuals living near the
ranged from 22.3% to 43.9%, with an average of
campus of the State University of Maringá, Maringá,
32.5%(3-4).
PR, Brazil. Small corrections were implemented in the
In virtually all nations, the prevention and control of SAH has important implications and the use of new
instrument after the pilot-study to improve the level of understanding it provided.
strategies and approaches to identify with greater
SAH was considered for self-reported cases. Socio-
accuracy the individuals at risk benefit both the
demographic variables were the predictor variables of
individuals with hypertension and society(5). Because
sex, age, marital status, and economic status, which was
SAH is a chronic disease, however, it requires monitoring
used to estimate the purchasing power of individuals
and treatment for life, involving both pharmacological
and families(8), who were grouped into: A1-A2, B1-B2,
and non-pharmacological measures(6).
C1-C2, and D-E. Variables regarding lifestyle included:
Considering the high levels of morbidity and
smoking, diet and exercise. Smoking referred to
mortality caused by cardiovascular diseases in Brazil and
individuals smoking regularly regardless of the number
in the world, and the prevalence of arterial hypertension
of cigarettes; individuals who did not exercise at least
coupled with a scarcity of studies addressing this topic
three times a week for at least 30 minutes per session
in small towns in the Southern region of Brazil, this
were considered to be inactive(9). Diet was considered
study’s aim was to identify the prevalence of arterial
inadequate when the intake of fruits and/or vegetables
hypertension and its association with cardiovascular risk
and/or legumes was below five times a week(7).
factors among adult individuals in Paiçandu, PS, Brazil.
Method This cross-sectional, population-based, descriptive study was conducted with adult individuals living in Paiçandu, PR, Brazil. This town has a total area of 170.64 km2 and an estimated population of 35,941 inhabitants, 19,776 of which are adults aged between 20 and 59 years old. To define the sample size, a prevalence of 50% of cardiovascular risk factors was considered together with an estimated error of 5% and reliability and precision of the sample is set at 95%, adding 10% for potential losses, resulting in 415 individuals. A total of 408 individuals aged between 20 and 59 years old, both sexes, participated in this study, while only valid data were considered for some variables.
Body mass (in kilograms) was assessed using a portable anthropometric digital scale (150 kilograms maximum capacity and accuracy to 0.1 kilograms). An anthropometric tape was used to measure height (in meters). The individual’s weight (in kilograms) divided by the squared height (in meters) was used to compute body mass index (BMI). The values were classified into: normal weight, when BMI >18.50 to 24.99 kg/m2; overweight, when BMI ≥25 to 29.99 kg/m2; and obese when BMI ≥30 kg/m2(9). Abdominal obesity (excessive fat in the abdominal region) was determined when WC was above 102 cm for men and 88 cm for women(9), measured at the midpoint between the costal margin and the iliac crest. The
outcome
morbidities,
such
variables as
diabetes
were
self-reported
mellitus
(DM)
and
dyslipidemia. To verify the presence of an agglomeration of risk factors, scores ranged from none (0) to five
www.eerp.usp.br/rlae
549
Radovanovic CAT, Santos LA, Carvalho MDB, Marcon SS. (5) or more risk factors. Zero was scored when there
Chi-square test was used to verify association with the
was no exposure to any factors, 1 – when there was
agglomeration of cardiovascular risk factors.
exposure to one factor, 2 – exposure to two risk factors,
The study was approved by the Institutional Review
3 – exposure to three factors, 4 – exposure to four
Board at the State University of Maringá (COPEP-UEM),
factors, and 5 – exposure to five or more risk factors.
process No. 173/2010. All the participants signed two
Data were recorded in a database in Microsoft Office
copies of free and informed consent forms.
Excel 2007; double entry was used to check later for inconsistencies,
and
data
analysis
was
Results
performed
using the R Environment for Statistical computing. The
Most of the 408 adults assessed were women
statistical analysis used to identify the Odds Ratio (OR)
(68.63%). The prevalence of SAH was 23.03%, higher
was univariate analysis considering hypertension in each
among women (24.64%) than among men (19.53%),
of the variables (sex, age, economic status, marital
though with no significant differences (Table 1). Average
status, exercise, diet, smoking, cholesterol, BMI, WC,
age was 39.9 years old ±12 years, while 47.71% of the
and DM). Multiple logistic regression was performed
individuals were aged between 50 and 59 years old. The
using SAH as the outcome and all the variables were
prevalent economic status was D-E, with 31.82% of the
considered. Afterwards, the model was reassessed and
individuals being hypertensive (Table 1).
only the variables significant at 5% were kept. Person’s
Table 1 - Prevalence of arterial hypertension according to socio-demographic profile. Paiçandu, PR, Brazil, 2011 Variable*
Total
SAH prevalence n
%
Raw OR (CI95%)
P-value
Sex (n=408)
0.311
Female
280
69
24.64
1
Male
128
25
19.53
0.77 (0.45-1.27)
100
09
9.00
1
30 to 39
94
14
14.89
1.71 (0.71-4.29)
40 to 49
105
19
18.10
2.21 (0.97-5.37)
50 to 59
109
52
47.71
8.76 (4.19-20.23)
A1-A2; B1-B2
129
20
15.75
1
C1-C2
248
67
27.02
1.99 (1.16-3.53)
D-E
22
07
31.82
2.26 (0.79-6.01)
No partner
132
30
22.73
1
Partner
275
63
22.91
0.99 (0.61-1.63)
Age groups – years (n=408)
