Hypertension management in São Paulo: insights from a computational simulation approach

Figures

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  Fig. 1. Core stock-and-flow structure of the hypertension dynamics model. Rectangles represent population stocks measured as number of people in each state (population with normal blood pressure, prehypertension, undiagnosed hypertension, diagnosed hypertension, treated hypertension, and controlled hypertension). Arrows represent flows measured as people moving between stocks per year, driven by prehypertension onset, progression to hypertension, diagnosis, treatment uptake, treatment dropout, and control rates. The diagram shown here is simplified for readability; the complete stock-and-flow structure is provided in the Supplementary Materials.

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  Fig. 2. Model validation and uncertainty analysis of key hypertension compartments, 2011–2045. Projected numbers of undiagnosed, diagnosed, treated, and controlled hypertensive populations are shown from 2011 to 2045. Black dotted lines indicate historical data up to 2023 used for behaviour reproduction testing. Shaded areas represent 95% uncertainty intervals derived from global sensitivity analysis with ±15% parameter variation. The widening intervals beyond 2030 reflect increasing structural and parametric uncertainty over time.

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  Fig. 3. Interactive interface of the hypertension Simulator. The interface enables real-time exploration of intervention scenarios and adjustment of key parameters. Output panels display projected trends in undiagnosed, diagnosed, treated, and controlled hypertension populations, as well as cardiovascular disease event rates over the 2011–2045 time horizon. Users can compare scenarios and explore sex-disaggregated outputs to assess differential impacts of interventions.

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  Fig. 4. Simulated impacts of intervention scenarios 1–5 on hypertension and cardiovascular disease outcomes, 2011–2045. Panels A–F show projected trends in (A) undiagnosed, (B) screened, (C) diagnosed, (D) treated, and (E) controlled hypertension populations, and (F) cardiovascular disease event rates. Lines represent different intervention scenarios as defined in Table 3. The accompanying heatmap quantifies percentage changes at 5, 10, and 15 years relative to the Base scenario. Shaded regions indicate 95% uncertainty intervals derived from global sensitivity analysis.

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  Fig. 5. Simulated impacts of comprehensive intervention scenarios (1, 5, 6, and 7) on hypertension and cardiovascular disease outcomes, 2011–2045. Panels A–F show projected trends in (A) undiagnosed, (B) screened, (C) diagnosed, (D) treated, (E) controlled hypertension populations, and (F) cardiovascular disease event rates under progressively integrated intervention strategies. The heatmap summarizes percentage changes at 5, 10, and 15 years relative to the Base scenario. Shaded regions indicate 95% uncertainty intervals from global sensitivity analysis.