Prevalence and risks associated with nondiagnosed arterial hypertension: comparative results in two Colombian cities

Prevalencia y riesgos asociados con la hipertensión arterial no diagnosticada: resultados comparativos en dos ciudades colombianas

According to the World Health Organization WHO ¹, high blood pressure represents the most important cause of premature death, causing around 9.4 million deaths from heart disease: early detection reduces complications from this cause. Its origin is multifactorial and is related to: race, age, gender, ^2-3; obesity ⁴ salt intake (> 60 mmol / day) ⁵, alcohol consumption ⁶, sedentary lifestyle ⁷, dyslipidemia, ⁸ smoking ⁹ and stress ¹⁰.

Complications of Arterial Hypertension (HBP) include coronary heart disease, pulmonary infections, and cerebrovascular accidents; ¹¹ the risk factor in men is 34.3% and in women it is 26.5% ¹². One in every 3 adults has high blood pressure, causing half of the deaths due to vascular brain injuries and heart disease ¹³. 11.5% of the population of Magdalena whose ages range from 18 to 69 years, admitted having had HBP and 9.1 % of them said to have been diagnosed as hypertensive; whereas, the death rate from cerebrovascular diseases was 37 per 100,000 inhabitants; which may precede arterial hypertension not opportunely identified, ¹⁴.

On the other hand, the National Health Institute ¹⁵ reported in 2013 that cardiovascular alterations represented the first cause of death among Colombians; its detection is essential to prevent heart attacks and strokes ¹⁶, whose factors are related to the traditional health model This happens due to unhealthy eating habits and sedentary lifestyle ¹⁷. Its asymptomatic presentation has been recognized as "the silent enemy" ¹⁸. Therefore, preventive practices would contribute to the solution of the problem. ¹⁹ This study aimed to identify the prevalence and contributing factors of undiagnosed hypertension in two Colombian cities.

Multicentric descriptive, transectional, non-experimental descriptive study conducted in two Colombian cities in a population of 3000 adults over 18 years of age, 2000 from Santa Marta and 1000 from Bucaramanga, through intention sampling; Patients previously diagnosed with the disorder were excluded. The blood pressure was measured according to WHO protocol ¹³ modified, only sitting and standing positions, according to the scale (normal: less than 12080 mmHg, prehypertension: 120-139 or 80-89 mmHg, Stage 1 hypertension: 140-159 mmHg or 90-99 mmHg, stage 2 greater than or equal to 160 or greater than or equal to 100 mmHg; ¹³ the body mass index consistent with the WHO assessment scale was obtained (Weight loss: <18.5, normal: 18.5-24.9, overweight> 25, obesity: 25.0-29.9, obesity class I: 30.0-34.9, obesity class 2: 35-39.9 and obesity class 3 :> 40) The sociodemographic information and associated factors (family history of hypertensive disorders, smoker and non-smoker, consumers or non-consumers of alcohol, practice or not of physical exercise), was collected through the application of a survey designed for these purposes, validated by experts and after signing informed consent, bioethical criteria were respected ²⁰ along with the declaration of Helsinki ²¹. The statistical analysis was carried out using the software Past, version 3.14 ²².

The behavior of the variables of the population per city is the following: in Santa Marta the median age was 35.5 with a lower limit value of 18 and higher than 95 years, the sex 54.85% (1117) female and 44.15% (883) male; whereas, in Bucaramanga, the median age was 32, with a lower limit of 18 and a higher limit of 91 years; 58% (580) female and 42% (420) male. In both cities, the predominant marital status was single, followed by free union marriage in Santa Marta and married in Bucaramanga. Regarding the socioeconomic stratum in Santa Marta, it was 1 (54.24%) and in Bucaramanga 3 (52.6%). The level of education of the population of Santa Marta was illiteracy and some grade of primary 27.55%; in Bucaramanga, the high school level predominated (21.5%). At the time of the study, 93.45% of the population of Santa Marta and 95.1% of the population in Bucaramanga was found to be affiliated with the social security system.

The frequency of undiagnosed or "silent" hypertension corresponded to 6.5% in Santa Marta and 3.4% in Bucaramanga, with a behavior of 78.1% and 91% of patients without the alteration. The non-diagnostic factor manifested by 100% of the population was the absence of signs and symptoms of arterial hypertension and the absence of controls on their health status. (See figure 1)

Graph 1
Distribution of the population according to blood pressure conditions
Source: Monitoring of blood pressure figures

Non diagnosed Hypertension in Santa Marta, according to gender, corresponded to 66.92% male and 33.08% female; socioeconomic stratum 1 (66.92%), unfinished primary school (18.46%). While in Bucaramanga male gender was (67.64%), socioeconomic stratum 3 (64.70%), complete high school (26.47%).

A positive association was found between risk factors and arterial hypertension in Santa Marta: family history (0.33), tobacco consumption ((0.97), alcohol consumption (0.20) and physical exercise (0.12) ) and in Bucaramanga: family history (0.95), tobacco consumption (0.73), alcohol (0.88) and absence of physical exercise (0.78) .The correlation between BMI and HTN was positive in Santa Marta and not associated in Bucaramanga, with a Spearman correlation of 0.5, and 0.0 respectively (See table 1)

Table 1
Factors associated with uncontrolled hypertension in both cities

Source: Statistic analysis

The behavior of the risk according to the body mass index in both groups was concentrated between 18 and 32, with a greater tendency towards the extreme right in the Santa Marta group. (See figure 2)

Figure 2
Distribution of body mass index in both cities
Source: Trend analysis of the body mass index.

The prevalence of undiagnosed hypertension was higher in the city of Santa Marta than in Bucaramanga, which may be related to better anthropometric condition, socioeconomic stratification and educational level. However, the prevalence of undiagnosed hypertension is lower compared to the results of Menéndez, who found 37.4% of cases undiagnosed ²³. Although the majority of the participants are affiliated to the Social Security System, actions for the early identification of alterations leave aside national regulations ^{24) (25}, as a mechanism to reduce the factors that cause cardiovascular diseases, in addition to the high prevalence of absenteeism from preventive and control programs ²⁶.

The male population presented a higher frequency of undiagnosed hypertension; fact that can be related to cultural characteristics and low assistance to health controls; result that goes in accordance with other studies ²⁷, ^{28) (23}, ²⁹. On the other hand, the representative socioeconomic stratum in Santa Marta coincides with Barceló ³⁰, who found that the less favored classes have a higher prevalence of arterial hypertension, where, in contrast, there was greater coverage of members of the Social Security System; while, in Bucaramanga, the educational level was concordant with Sánchez's study ³¹. In Santa Marta, there was influence of the body mass index with the abdominal girth, while in Bucaramanga no association was found, contrasting results with Cardona's findings ²⁸. The risk factors associated with undiagnosed hypertension are similar with that found by García ²⁹.

These results allow proposing strategies aimed at the early diagnosis of hypertensive disorders. It is recommended to follow up on positive cases, as well as to implement care programs and university extension-research actions, in partnership with the health secretaries, so that through screening tests, new cases are monitored.

These results allowed toidentify the prevalence of undiagnosed hypertension in two Colombian cities, marked by the non-perception of signs and symptoms; with higher prevalence in Santa Marta than in Bucaramanga. The behavior of the risk factors was similar in both cities.

The researchers thank the community that participated in the study.