Epidemiological analysis of systemic arterial hypertension in the Quilombola do Curiaú community in the state of Amapá

ORIGINAL ARTICLE

SANTOS FILHO, João Gilberto Sakai ^[1], PENA, Eduarda Emanuelle da Silva ^[2], ESPINDOLA, Gabriel de Oliveira ^[3], BRITO, Maiara de Fátima de Brito ^[4], RESQUE, Rafael Lima ^[5], BARBOSA, Robson Carvalho ^[6], VANZELER, Tainá Lobato ^[7]

SANTOS FILHO, João Gilberto Sakai. Et al. Epidemiological analysis of systemic arterial hypertension in the Quilombola do Curiaú community in the state of Amapá. Revista Científica Multidisciplinar Núcleo do Conhecimento. Year. 07, Ed. 01, Vol. 06, p. 140-153. January 2022. ISSN: 2448-0959, Access link: https://www.nucleodoconhecimento.com.br/health/epidemiological-analysis

ABSTRACT

With high prevalence and low control rates, Systemic Arterial Hypertension (SAH) is one of the main modifiable risk factors for cardiovascular diseases and one of the most important public health problems. Guiding question: What is the prevalence and associated factors of SAH in the Quilombola Community of Curiaú? Objective: The objective of this study was the epidemiological analysis of the prevalence of SAH and factors associated with it in the Quilombola Community of Curiaú. Material and Methods: This is a descriptive cross-sectional study, being carried out with 71 volunteers, aged ≥ 18 years and residing in the community. Results: The mean age of the volunteers was 49.01 years, 64.7% (n=46) were female and 35.2% (n=25) were male. It was observed that 32.8% (n=24) of the participants were hypertensive, being 33.4% (n=8) men and 66.6% (n=16) women, among these 50% (n=12) were on antihypertensive therapy. Among the participants, it was found that 70.8% had a family history of hypertension, in addition, 33.8% of the volunteers had high blood pressure levels. Conclusion: A high prevalence of SAH and high blood pressure levels were observed in the Quilombola community of Curiaú, especially female individuals, as they were the ones who most presented the disease. Also, a higher prevalence of SAH was detected in people aged ≥ 60 years. In this way, it is necessary that there is greater attention to public health policy and the implementation of programs that focus on the drug treatment of this quilombo.

Keywords: Afro-descendants, Quilombolas, Arterial Hypertension.

1. INTRODUCTION

SAH is a chronic non-communicable disease (NCD), defined by a sustained increase in blood pressure linked to multiple aggravating factors, such as: poor diet, lack of physical exercise, smoking, excessive amounts of alcohol or sodium, stress, obesity and genetics. (BARROSO, 2021).

With high prevalence and low control rates, SAH is one of the main modifiable risk factors for cardiovascular diseases and one of the most important public health problems today (BRANDÃO, 2010). SAH tends to be asymptomatic, causing implications for the difficulty of early diagnosis and low patient adherence to the prescribed treatment, since there are drugs that have side effects, therefore, the control of SAH becomes ineffective (MONTEIRO et al. ., 2020).

Lobo et al. (2017) found data on the Brazilian population that pointed to an increase in the prevalence of SAH, where the association with low levels of education, low-income women and, in men, those with the highest financial income stand out.

In Brazil, SAH is more prevalent and severe in populations with pronounced African descent. In this way, the remaining quilombo population residing in Curiaú, in the State of Amapá, can be chosen as a point of greater attention in this regard, since it historically presents a greater Afro-descendant genetic contribution than the mixed-race Brazilian populations residing in urban centers (LINDHORST et al. ., 2007; KURIAN; CARDARELLI, 2007; BARROS et al., 2006).

Thus, the relevance of an ethnic-racial study on diseases and social determinants is pertinent in more susceptible populations. In this context, the guiding question of this article was: What is the prevalence and associated factors of SAH in the Quilombola Community of Curiaú? Therefore, the objective of this work was to carry out an epidemiological analysis of SAH and identify factors associated with this disease in residents of the quilombo community of Curiaú.

There is a simple amount of studies on the black population in Brazil, especially on Afro-descendants from the quilombolas, in this sense the present study contributes to the expansion of the visibility of the inequalities that affect the quilombola population, in addition to identifying health needs and the promotion of therapeutic interventions , in order to help with the planning of actions aimed not only at preventing hypertension, but also at controlling SAH.

2. MATERIALS AND METHODS

This was a descriptive cross-sectional study for the epidemiological analysis of SAH in the Quilombola Community of Curiaú in the State of Amapá. The inclusion criteria were: being adults (aged 18 years or older), living in the Curiaú community who agreed to participate in the research and signed the Free and Informed Consent Form (FICT); and those of exclusion: non-residents of the community, as well as minors or those considered incapable of deciding to participate. Based on these criteria, the sample consisted of 71 volunteers residing in the Curiaú community.

2.1 DATA COLLECTION AND VARIABLES

Data collection was carried out from August to December 2019. The variables studied were: gender (female or male); age and age group (18 to 29 years old, 30 to 59 years old and over 60 years old); ethnicity (European, African, indigenous and Asian), marital status, lifestyle, such as: consumption of alcohol and cigarettes (sporadically, weekly, daily, no use); diseases present: systemic arterial hypertension (SAH) and the existence of other diseases were assessed through dichotomized questions (yes or no); measures such as blood pressure measurement and blood glucose testing, in addition to the use of antihypertensive drugs.

Measurements and classification of blood pressure (BP) levels followed the protocol contained in the VII Brazilian Guidelines on Arterial Hypertension. The subjects were instructed to have an empty bladder, not to exercise for at least 60 minutes, and not to have consumed alcohol, cigarettes, coffee or food in the previous 30 minutes.

Blood pressure measurements were taken twice (with a 2-minute interval between each measurement) using the OMRON-HEM 6124 digital sphygmomanometer, according to the criteria established by the Brazilian Guidelines on Arterial Hypertension (BARROSO et al., 2020). After resting for between three and five minutes, the participants were seated, legs uncrossed, feet flat on the floor, back leaning against the chair and relaxed, with the left arm resting on the table at heart level. The result of the average of the last two measurements was considered as the final pressure value. People with BP whose blood pressure levels were less than 140 per 90 mmHg were considered within the normal range.

2.2 STATISTICAL ANALYSIS

The BioStat 5.0 program was used for the statistical analysis of epidemiological data (mean age and coefficient of variation). The dependent variables were submitted to tabulation in a spreadsheet and analyzed by means of correlation with the chi-square test (χ2) using the Microsoft® Office Excel 2013 program.

2.3 ETHICAL ASPECTS

The research project was submitted, in accordance with Resolution No. 466/12, for evaluation by Plataforma Brasil and the Research Ethics Committee (CEP), located at the Federal University of Amapá – UNIFAP. Approval of the study is registered under identification number CAAE[8] 14952919.5.0000.0003.

Participants were informed about the purpose of the research and instructed to sign the Free and Informed Consent Term, authorizing the use of their sample in the study.

3. RESULTS AND DISCUSSION

The study involved the participation of 73 quilombola individuals residing in the community of Curiaú. Among the 73 volunteers who participated in the research, 71 (96.2%) were those who participated in the entire study process. There was a 3.7% reduction in participants because they were not included in the established criteria. Most participants were female, 46 (64.7%) and 25 (35.2%) male. Regarding age, those aged between 18 and 29 years old totaled 11 (15.49%), from 30 to 59 years old 38 (53.52%) and those over 60 years old totaled 22 (30.98%).

In addition, 85.9% of respondents declared they were of African origin, 9.8% of indigenous origin, 1.4% said they were of European origin and 2.8% did not know or did not want to inform. With regard to marital status, it was observed that 42.2% are married and/or live with someone from the same community.

A similar profile was also found in the study by Santos et al. (2020), carried out with quilombola adults in Bahia, where the age variation found among the participants was from 18 to 92 years, with a median of 45 years. The sample was predominantly composed of women, totaling 61.1% of these. Among the participants, 86.5% self-reported black and 76.7% of the individuals reported having a spouse.

Regarding the profile of patients with SAH, it was possible to identify a higher prevalence of the disease in women, around 34.7% (Table 1), in addition, there was a significant prevalence in the age group of 30-59 years and 60 years or older. more. According to data from the analysis of the 2013 National Health Survey, mentioned in the study by Andrade et al. (2015), a prevalence of 21.4% was found, being higher among women 24.2%, and in individuals over 75 years of age 55.0% and of black race/color 24.2%.

Table 1 – SAH relationship – Gender

Source: Author data, 2019.

In a study carried out with a niche of adults in the sertão of Pernambuco, the prevalence of SAH in the amount of 27.4% was evidenced, showing increasing with increasing age and decreasing level of education, in addition, there is a higher prevalence of hypertension. disease in people of lower economic classes (SANTIAGO et al., 2019).

Above all, among those who had SAH, it was found that 70.8% had a family history of hypertension, with women having a greater number of people with SAH in their families, about 76% (n=35) and men , showed 56% (n=14). No significant association was observed between family history of SAH and sex in the community of Curiaú (p=0.080). In a survey carried out with hypertensive patients and associated Diabetes Mellitus (DM), registered in a Family Health Strategy (ESF) in Minas Gerais, it was identified that 70% of respondents had a family history of SAH or DM (PRATES et al., 2020).

Of the participants in the present study diagnosed as hypertensive (n=24), 12 (50.0%) were being treated with an antihypertensive drug of the ARA class (angiotensin II receptor antagonists) associated with a diuretic of the thiazide class and 60, 0% (n=6) did not have controlled BP, even using medication, being 17% (n=1) male and 83% (n=5) female. Menezes; Portes and Silva (2020) identified, among the hypertensive individuals in their study, that among the 73% who knew they had the disease, 95% of them were undergoing treatment, but only 49% of them maintained adequate blood pressure control, reflecting the dichotomy of neglected treatment. .

In table 2, it is possible to visualize the results of blood pressure control with the application of drug therapy and, despite women having greater self-care, especially with regard to faster seeking care, the statistical data were not statistically significant (p. =0.144) and show that females in this study have the least control of SAH.

Table 2 – Prevalence and control of SAH, according to sex, in the Quilombola population of Curiaú.

Source: Author data, 2019.

The results obtained by the lack of BP control, despite the use of drug therapy with antihypertensive drugs, may suggest a type of DRP (Drug-Related Problems), since the effectiveness of these drugs is deficient, since the interviewees said they had medication adherence. It is therefore necessary to have a close monitoring with these volunteers so that the real reason for the ineffectiveness of these drugs can be investigated and thus seek to solve this individual problem.

In a study carried out with 270 hypertensive patients, it was observed that 63% of the participants adhered to treatment with antihypertensive drugs in people with hypertension and, when the adherence deficit was noticed, it was primarily caused by carelessness in the taking the medication, evidencing a problem of a cultural nature (ALBUQUERQUE et al., 2018).

Regarding the use of medication, 14.08% (n=10) of those who participated in this research reported having some type of ADR (adverse drug reaction) such as: nausea, vertigo, headache, localized pain in the stomach, among others. On the other hand, it was verified through the interviews that the adherence to the use of natural products decreases the use of medicines when necessary.

According to Barroso et al. (2021) for blood pressure control, drug treatment is a valid option, however, changes in eating habits and lifestyle in general are also necessary, and should be a priority for the patient whenever possible. To improve the control of SAH, strategies that consist of organizational interventions centered on the patient and their health determinants, led by multidisciplinary teams, can be used, aiming to improve the quality of hypertension care and, consequently, the quality of life (JARDIM et al. , 2020).

Among the volunteers, it was observed that 33.8% (n=23) had increased blood pressure (≥140/90 mmHg) and among these, 19.7% (n=14) had a diagnosis of arterial hypertension. Among the participants with altered blood pressure, 43.4% (n=10) were women and 56.5% (n=13) were men. There was a statistically significant difference (p=0.009) between the genders regarding the classification of the samples in relation to the elevation of blood pressure levels, with a higher level of high BP among men, evidencing some facts noted in men’s health care, where individuals from the males take longer to seek health care and, with this, the late diagnosis of several pathologies, including SAH.

In this sense, Song et al (2020) states that men have lower levels of perception of hypertension and a higher incidence of this disease compared to women of the same age before the sixth decade of life.

As for the classification of volunteers who have a diagnosis of SAH, there was no significant difference between genders (p=0.813). It is possible to observe that in this study, sex does not present a risk factor for SAH in the community of Curiaú.

In the study by Lobo et al. (2017) there were higher prevalences of SAH in individuals with less schooling, regardless of the years studied and gender.

In relation to the interviewees who had increased blood pressure (with and without a diagnosis of hypertension), only 1.4% (n=1) aged between 18 and 39 years had increased BP. Between 30 and 59 years old, 21.1% (n=15) had altered BP values ​​and in individuals aged 60 years or older, 18.3% (n=13) had values ​​above those considered normal. In view of the observed results, there was a significant association between age group and elevation of blood pressure in this study (p=0.015) (Chart 3). It is important to note that 2 volunteers had no interest in measuring BP at the time of the research.

Table 3 – Data on blood pressure elevation in the study population.

Source: Author data, 2019.

Regarding alcohol consumption and smoking, the volunteers answered questions regarding the frequency of their use. Among the interviewees: 32.3% (n=23) sporadically use alcohol, 8.4% (n=6) consume alcohol weekly and 3 (n=4.2%) drink daily. Finally, 39 (54.9%) of respondents said they did not drink alcohol. Regarding cigarette consumption, only 1.4% (n=1) of the volunteers smoked sporadically, 2.8% (n=2) used it weekly, 7% (n=5) said they smoked daily and 88.7% ( n=63) of the participants said they did not smoke (Chart 4).

Table 4- Relation of alcohol and cigarette consumption in the study population.

Source: Author data, 2019.

It is estimated that excessive alcohol consumption is responsible for around 10-30% of SAH cases and around 6% of all-cause mortality worldwide (BARROSO et al., 2021.) In the analysis by Santos et al. al. (2019), smoking was one of the risk factors that were associated with AH, with a total percentage of smokers of 37.18%. Therefore, smoking is recognized as a risk factor for the onset of hypertension in adults.

4. FINAL CONSIDERATIONS

Studies with groups considered vulnerable are scarce, so the importance of this work for the academic community and society in general is highlighted, as it aimed to analyze the epidemiological characteristics that may be associated with SAH in the population of the Quilombola Community of Curiaú. The identification of hypertensive individuals may allow tracking and sensitization of a group with the highest cardiovascular risk and of progression to other comorbidities or worsening of the existing disease.

Thus, taking into account that the Ministry of Health conceptualizes health as biopsychosocial well-being involving several aspects, the study of Systemic Arterial Hypertension in vulnerable groups is relevant. Among the various parameters discussed here, education, age and sex of the individuals stood out. Therefore, answering the guiding question: What is the prevalence and associated factors of SAH in the Quilombola Community of Curiaú? Among the results of the prevalence of SAH found in this study, several existing factors were considered, which expands the analysis of prevalence among different populations and places. However, this study revealed that SAH is an important health problem in the community of Curiaú and, in particular, female individuals, as they were the ones who most presented the disease. A higher prevalence of hypertension was also detected in individuals aged ≥ 60 years, being an age group considered a risk factor for SAH due to the aging process.

Concomitantly, when analyzing the volunteers who presented elevation of pressure levels, it is possible to observe that male individuals presented elevation in relation to age. People in the age group between 30 and 59 years old were the ones who most presented high BP. This must be taken into account, as they present a greater risk of developing SAH, and must be monitored frequently.

The results of the present study, when compared with other works in Afro-descendant remnants, demonstrate the prevalence of SAH in the Quilombola Community of Curiaú, associated with known and specific risk factors, focusing attention on the need to implement public policies that cover the need to investigate the determinants of health and their implications in relation to health care for quilombolas, in addition to programs that consider adherence to drug therapy, focusing on improving the quality of life and promoting public health for the population of this community.

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BARROS, Marilisa Berti; CÉSAR, Chester Luiz; CARANDINA, Luana; TORRE, Graciella

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BARROSO, Weimar Kunz Sebba et al. Diretrizes Brasileiras de Hipertensão Arterial. 2020. Arquivos Brasileiros de Cardiologia, v. 116, p. 516-658, 2021.

BRANDÃO, Andréa A. et al. Conceituação, epidemiologia e prevenção primária. Brazilian Journal of Nephrology, v. 32, p. 1-4, 2010.

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KURIAN, Anita; CARDARELLI, Kathryn. Racial and ethnic diferences in cardiovascular disease risk factors: a systematic review. Ethn Dis., 17(1):143-152, 2007.

LINDHORST, Jane; ALEXANDER, Nichole; BLIGNAUT, Juliet; RAYNER, Brian. Differences in hypertension between blacks and whites: an overview. Cardiovasc J Afr., 2007;18(4):241-247, 2007.

LOBO, Larissa Aline Carneiro et al. Tendência temporal da prevalência de hipertensão arterial sistêmica no Brasil. Cadernos de Saúde Pública, v. 33, 2017.

MENEZES, Thiago de Castro; PORTES, Leslie Andrews; SILVA, Natália Cristina de Oliveira Vargas. Prevalência, tratamento e controle da hipertensão arterial com método diferenciado de busca ativa. Cadernos Saúde Coletiva, v. 28, p. 325-333, 2020.

MONTEIRO, Ariane Alice Fernandes et al. Estudo sobre a adesão ao tratamento de hipertensão arterial sistêmica na UBSF de Três Poços. Brazilian Journal of Health Review, v. 3, n. 1, p. 1289-1305, 2020.

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APPENDIX – FOOTNOTE

8. Certificate of Presentation of Ethical Appreciation.

^[1] Graduating in Pharmaceutical Sciences at the Federal University of Amapá. ORCID: 0000-0002-3181-6630.

^[2] Specialization in Specialization in Criminal Forensics. Institute of Graduate Studies and Research in Health Sciences of Amapá, IECSA, Brazil. Graduation in Biological Sciences, Federal University of Amapá, UNIFAP, Brazil. ORCID: 0000-0002-8181-8773.

^[3] Master in Health Sciences, Federal University of Amapá, UNIFAP, Brazil. Ongoing Specialization in Molecular Biology and Forensic Genetics, National Institute of Forensic Forensics and Sciences, INFOR, Brazil. Graduation in Biological Sciences, Federal University of Amapá, UNIFAP, Brazil. ORCID: 0000-0002-0749-4627.

^[4] Graduated in Pharmaceutical Sciences from the Federal University of Amapá. ORCID: 0000-0002-6302-8647.

^[5] PhD in Genetics and Molecular Biology from the Federal University of Pará, UFPA, Brazil. Master in Genetics and Molecular Biology from the Federal University of Pará, UFPA, Brazil. Specialization in Genetics and Molecular Biology from the Lutheran University of Brazil, ULBRA, Brazil.Graduate in Pharmacy from the University Center of the State of Pará, CESUPA, Brazil. ORCID: 0000-0002-5769-5734.

^[6] Master’s Degree in Pharmaceutical Sciences, Federal University of Amapá, UNIFAP, Brazil. Ongoing specialization in the Specialization Course in Criminal Forensics. Institute of Graduate Studies and Research in Health Science of Amapá, IECSA, Brazil. Graduation in BIOMEDICINE. Estácio de Macapá College, Estácio Macapá, Brazil. ORCID: 0000-0001-6826-8327.

^[7] Master in Health Sciences, Federal University of Amapá, UNIFAP, Brazil. Graduation in Biological Sciences, Federal University of Amapá, UNIFAP, Brazil. ORCID: 0000-0002-0940-0102.

Submitted: January, 2022.

Approved: January, 2022.