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Hypertension in a Brazilian Urban Slum Population

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Abstract

Low- and middle-income countries account for the majority of hypertension disease burden. However, little is known about the distribution of this illness within subpopulations of these countries, particularly among those who live in urban informal settlements. A cross-sectional hypertension survey was conducted in 2003 among 5649 adult residents of a slum settlement in the city of Salvador, Brazil. Hypertension was defined as either an elevated arterial systolic (≥140 mmHg) or diastolic (≥90 mmHg) blood pressure. Sex-specific multivariable models of systolic blood pressure were constructed to identify factors associated with elevated blood pressure. The prevalence of hypertension in the population 18 years and older was 21 % (1162/5649). Men had 1.2 times the risk of hypertension compared with women (95 % confidence intervals (CI), 1.05, 1.36). Increasing age and lack of any schooling, particularly for women, were also significantly associated with elevated blood pressure (p < 0.05). There was also a direct association between men who were black and an elevated blood pressure. Among those who were hypertensive, 65.5 % were aware of their condition, and only 36.3 % of those aware were actively using anti-hypertensive medications. Men were less likely to be aware of their diagnosis or to use medications (p < 0.01 for both) than women. The prevalence of hypertension in this slum community was lower than reported frequencies in the non-slum population of Brazil and Salvador, yet both disease awareness and treatment frequency were low. Further research on hypertension and other chronic non-communicable diseases in slum populations is urgently needed to guide prevention and treatment efforts in this growing population.

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Acknowledgments

Other members of the Pau da Lima Urban Health Team included Rosan Barbosa, Reinaldo Barreto, Jorge Costa, Maria Raimunda da Cruz, Ana Carla Duarte, Leila Gouveia, Analéa Lima, Simone Nascimento, Osmar Paixão, Amaro Silva, and Érika Sousa from the Oswaldo Cruz Foundation and the Residents’ Association of Pau da Lima, Salvador, Brazil. We would like to thank Claudio Pereira da Sá, Edilane Gouveia, and Marília Sá Carvalho for the assistance with the preliminary statistical analysis, and Salvatore Cala and Emanuel Costa for their support with data management and administration, as well as the Pau da Lima Health District and the Municipal Secretary of Health of Salvador for coordinating care for those enrolled in the study. Lastly, this work could not have been accomplished without the joint collaborative effort of the Residents’ Associations, leaders, and members of the Pau da Lima community.

Author Contributions

AK, RF, VC, and FS formulated the original idea and designed the study together with the resident associations of Pau da Lima. RF, SM, VC, AM, RR, and FS collected the data. MR and AK supervised the field team. AU and RS performed the data analysis. AU wrote the initial draft with RS. AK, LR, and GR critically reviewed the manuscript and helped to prepare the final version. All authors approved the final manuscript prior to submission.

Funding

This work was supported by the Brazilian National Research Council (grant 300.861/96-6), Oswaldo Cruz Foundation (grant 0250.250.102), and the US National Institutes of Health (grants R01 AI052473, U01 AI088752, D43 TW00919, R25 TW009338). A Unger was supported by a Fogarty International Center/Ellison Medical Foundation Fellowship in Global Health and Clinical Research (grant TW00018).

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    1. Division of Hospital Medicine, University of California, San Francisco, 533 Parnassus Ave, Suite U127A, Box 0131, San Francisco, CA, 94143, USA

      Alon Unger

    2. Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Ministério da Saúde, Salvador, Brazil

      Alon Unger, Ridalva D. M. Felzemburgh, Guilherme S. Ribeiro, Sharif Mohr, Vinícius B. A. Costa, Astrid X. T. O. Melendez, Renato B. Reis, Francisco S. Santana & Mitermayer G. Reis

    3. Institute of Collective Health, Federal University of Bahia, Salvador, Brazil

      Guilherme S. Ribeiro

    4. Divisions of Infectious Disease and Vaccinology, and Epidemiology, School of Public Health, University of California, Berkeley, CA, USA

      Robert E. Snyder & Lee W. Riley

    5. Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, USA

      Albert I. Ko

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    Correspondence to Alon Unger.

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    Ridalva D. M. Felzemburgh and Robert E. Snyder contributed equally to this work.

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    Unger, A., Felzemburgh, R.D.M., Snyder, R.E. et al. Hypertension in a Brazilian Urban Slum Population. J Urban Health 92, 446–459 (2015). https://doi.org/10.1007/s11524-015-9956-1

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