Pharmaceutical Care in Primary Care: an Experience with Hypertensive Patients in the North of Brazil

Abstract Background: Uncontrolled blood pressure has been associated with poor adherence to drug treatment. Objectives: To assess blood pressure control in hypertensive patients attending primary health centers after implementation of a pharmaceutical follow-up program in a city of the north of Brazil. Methods: Observational, cross sectional, descriptive study with 163 hypertensive patients attending public primary health care centers - one located on the riverside and one in the urban area of the city of Santarem, western Pará, Brazil. Adherence to the anti-hypertensive treatment was assessed using the eight-item Morisky test. Pharmacotherapy follow-up (Dader method) of patients with uncontrolled hypertension and non-adherent to anti-hypertensive treatment was performed. Results of the normality test showed that the data did not follow a normal distribution. Continuous variables were then compared using the Wilcoxon signed-rank test, and categorical variables by the likelihood ratio and the McNemar tests. Statistical significance was set at 5%. Results: Of the total sample, 94.5% were not adherent to anti-hypertensive drug therapy and 77.2% had uncontrolled hypertension. Adherence rate was higher in men than women (p=0.006). Pharmacotherapy follow-up improved blood pressure levels, particularly systolic blood pressure (p<0.001). Conclusion: An individualized pharmacotherapeutic follow-up, considering regional and cultural specificities, can contribute to the treatment of hypertensin in the primary care.

Comparative study on mortality due to cardiovascular diseases in São Caetano do Sul, São Paulo, Brazil, between 1980 and 2010. / Estudo comparativo de mortalidade por doenças cardiovasculares em São Caetano do Sul (SP), Brasil, no período de 1980 a 2010.

Analysis of the mortality due to cardiovascular diseases (CVD) can provide subsidies for preventive and control measures. The goal of this article is to compare CVD mortality rates in São Caetano do Sul, the state of São Paulo and the country as a whole. Standardized mortality and mortality due to CVD were calculated for the 1980-2010 period. We found a significant reduction in cardiovascular mortality in all three study units during this period, with the largest reduction in CVD in São Caetano do Sul. The largest mortality rate was found in the state of São Paulo. In adults 30 to 59, the CVD mortality rate in São Caetano do Sul was three times as high in men as in women, yet among adults 60 and older, CVD mortality was higher in women than in men. The lower rate is the result of implementing different healthcare policies. However, specific interventions are required that focus on changes in lifestyle, especially among adult men and the elderly.

Estudo comparativo de mortalidade por doenças cardiovasculares em São Caetano do Sul (SP), Brasil, no período de 1980 a 2010 / Comparative study on mortality due to cardiovascular diseases in São Caetano do Sul, São Paulo, Brazil, between 1980 and 2010

Resumo A análise do comportamento da mortalidade por doenças cardiovasculares (DCV) pode subsidiar medidas de prevenção e controle quanto à sua ocorrência. O objetivo deste artigo foi comparar taxas de mortalidade por DCV no município de São Caetano do Sul, no estado de São Paulo e no Brasil. Foram calculadas as taxas padronizadas de mortalidade e mortalidade proporcional por DCV de 1980 a 2010. Observou-se redução importante da mortalidade cardiovascular no período de 1980 a 2010 nas três unidades de estudo, sendo que a redução maior foi em São Caetano do Sul. O estado de São Paulo foi a unidade que apresentou maior taxa de mortalidade. Já São Caetano do Sul apresentou a maior média de mortalidade por DCV. Por outro lado, em São Caetano do Sul, a taxa de mortalidade por DCV foi três vezes maior em homens, em comparação às mulheres na faixa etária dos 30 aos 59 anos, e maior em mulheres em relação aos homens com idade superior a 60 anos. A redução dos índices é resultado da implementação de diferentes políticas de saúde pública. Todavia, são necessárias intervenções específicas voltadas a mudanças no estilo de vida, principalmente dos homens adultos e dos idosos.

Abstract Analysis of the mortality due to cardiovascular diseases (CVD) can provide subsidies for preventive and control measures. The goal of this article is to compare CVD mortality rates in São Caetano do Sul, the state of São Paulo and the country as a whole. Standardized mortality and mortality due to CVD were calculated for the 1980-2010 period. We found a significant reduction in cardiovascular mortality in all three study units during this period, with the largest reduction in CVD in São Caetano do Sul. The largest mortality rate was found in the state of São Paulo. In adults 30 to 59, the CVD mortality rate in São Caetano do Sul was three times as high in men as in women, yet among adults 60 and older, CVD mortality was higher in women than in men. The lower rate is the result of implementing different healthcare policies. However, specific interventions are required that focus on changes in lifestyle, especially among adult men and the elderly.

[Unequal trends in causes of death in Brazilian regions]. / Evolución desigual de las causas de muerte en las regiones de Brasil.

OBJECTIVE: To determine changing patterns in the main causes of mortality Brazilian regions between 1980 and 2000 taking into consideration the inequalities among territories and epidemiological transition. MATERIAL AND METHODS: Data was gathered from the Information System of the state of São Paulo. Age-standardized mortality rates were calculated using the European population as reference. The average annual increase was calculated using linear regression models. RESULT: Mortality rates due to ill-defined causes of death, assaults and homicide, and HIV infection increased in men and women while mortality due to cardiovascular disease, pneumonia and influenza significantly decreased. CONCLUSION: The epidemiological transition in Brazil differs from that of developed countries and other Latin American countries, since causes of death connected with both developed and developing countries coexist.

Evolución desigual de las causas de muerte en las regiones de Brasil / Different triends in causes of death in Brazilian regions

Objetivo: Conocer la evolución de la mortalidad por las principales causas en un región de Brasil entre 1980 y 2000, teniendo en cuenta las desigualdades entre territorios y la transición epidemiológica. Material y métodos: Los datos proceden de las bases del Sistema de Información del Estado de São Paulo. Se calcularon las tasas de mortalidad estandarizadas por edad y el aumento medio anual mediante modelos de regresión lineal. Resultados: Se observó un incremento significativo de la tasa de mortalidad por las causas mal definidas, agresión y homicidio e infección por el virus de la inmunodeficiencia humana tanto en hombres como en mujeres, y un descenso significativo en las muertes por enfermedades cardiovasculares, neumonía e influenza. Conclusión: La transición epidemiológica en Brasil no se ajusta ni al modelo de los países desarrollados ni a otros de Latinoamérica, ya que coexisten causas de muerte ligadas tanto al retraso como al desarrollo

Objective: To determine changing patterns in the main causes of mortality Brazilian regions between 1980 and 2000 taking into consideration the inequalities among territories and epidemiological transition. Material and methods: Data was gathered from the Information System of the state of São Paulo. Age-standardized mortality rates were calculated using the European population as reference. The average annual increase was calculated using linear regression models. Result: Mortality rates due to ill-defined causes of death, assaults and homicide, and HIV infection increased in men and women while mortality due to cardiovascular disease, pneumonia and influenza significantly decreased. Conclusion: The epidemiological transition in Brazil differs from that of developed countries and other Latin American countries, since causes of death connected with both developed and developing countries coexist