Key result
Between 1990 and 2017, age-standardized death rates attributable to high systolic blood pressure in Brazil decreased by 44.6%, although the total number of attributable deaths increased by 53.4% due to population aging.
Why the study?
Hypertension remains the leading risk factor for CVD worldwide, and its impact in Brazil needed to be assessed to better address the issue.
Observational
While age-standardized mortality rates from high systolic blood pressure have decreased in Brazil, the absolute number of deaths and overall prevalence have increased, driven largely by population aging.
Answers are grounded in this paper and cite their sources.
Provides subnational HSBP trends for Brazil; extends GBD modeling but leaves practice change open.
BACKGROUND: Hypertension remains the leading risk factor for cardiovascular disease (CVD) worldwide, and its impact in Brazil should be assessed in order to better address the issue. We aimed to describe trends in prevalence and burden of disease attributable to high systolic blood pressure (HSBP) among Brazilians ≥ 25 years old according to sex and federal units (FU) using the Global Burden of Disease (GBD) 2017 estimates. METHODS: We used the comparative risk assessment developed for the GBD study to estimate trends in attributable deaths and disability-adjusted life-years (DALY), by sex, and FU for HSBP from 1990 to 2017. This study included 14 HSBP-outcome pairs. HSBP was defined as ≥ 140 mmHg for prevalence estimates, and a theoretical minimum risk exposure level (TMREL) of 110-115 mmHg was considered for disease burden. We estimated the portion of deaths and DALYs attributed to HSBP. We also explored the drivers of trends in HSBP burden, as well as the correlation between disease burden and sociodemographic development index (SDI). RESULTS: In Brazil, the prevalence of HSBP is 18.9% (95% uncertainty intervals [UI] 18.5-19.3%), with an annual 0.4% increase rate, while age-standardized death rates attributable to HSBP decreased from 189.2 (95%UI 168.5-209.2) deaths to 104.8 (95%UI 94.9-114.4) deaths per 100,000 from 1990 to 2017. In spite of that, the total number of deaths attributable to HSBP increased 53.4% and HSBP raised from 3rd to 1st position, as the leading risk factor for deaths during the period. Regarding total DALYs, HSBP raised from 4th in 1990 to 2nd cause in 2017. The main driver of change of HSBP burden is population aging. Across FUs, the reduction in the age-standardized death rates attributable to HSBP correlated with higher SDI. CONCLUSIONS: While HSBP prevalence shows an increasing trend, age-standardized death and DALY rates are decreasing in Brazil, probably as results of successful public policies for CVD secondary prevention and control, but suboptimal control of its determinants. Reduction was more significant in FUs with higher SDI, suggesting that the effect of health policies was heterogeneous. Moreover, HSBP has become the main risk factor for death in Brazil, mainly due to population aging.
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Nascimento et al. (2020) conducted an observational in High systolic blood pressure. High systolic blood pressure vs. 1990 baseline was evaluated on Age-standardized death rates attributable to HSBP per 100,000 (44.6% reduction, 95% CI 42.9-45.9). Between 1990 and 2017, age-standardized death rates attributable to high systolic blood pressure in Brazil decreased by 44.6%, although the total number of attributable deaths increased by 53.4% due to population aging.
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