High blood pressure treatment is still a challenge in Brazil – 04/20/2023 – Folha Seminars

Brazil has one of the best hypertension control scenarios in the Americas, with higher rates of diagnosis and treatment than neighboring countries such as Argentina and Peru. Much progress is needed, however, to reach numbers similar to those of the United States and Canada, which record the highest rates on the continent.

Experts point out that the main obstacle to this is the inconsistency in the pace of consultations and treatment of the disease, especially among the poorest population.

In this respect, Chile and India have successful programs. The former is frequently praised by international organizations for its success in caring for hypertensive patients. The second received a WHO award in September for an initiative to expand control of the disease.

Popularly known as high blood pressure, the disease occurs when the blood exerts excessive force when passing through the blood vessels, causing damage to the walls of the arteries. With this, the risk of obstruction increases, which increases the likelihood of heart attack, stroke, heart failure and kidney disease.

Prevention of the condition involves exercising and eating a balanced diet. Treatment is already done with lifestyle change and continuous use remedies.

India’s Hypertension Control Initiative (IHCI) is a tool developed by the government to reduce the number of hypertensives by 25% by 2025 — in line with WHO guidelines.

Cardiovascular diseases are responsible for one third of all deaths in the country. In addition, 220 million Indians are hypertensive and, of these, only 12% have the pressure under control, according to the UN.

The program, created in 2017, seeks to standardize treatment and guarantee the supply of medicines in all regions. Currently, the initiative encompasses 3.4 million people – a number well below the total number of cases.

IHCI also integrates health professionals from various areas to treat patients and manages an information system for tracking.

Patient visits and progress are recorded in an app. In addition, the person himself can write down his blood pressure and sugar levels – the tool is also part of a diabetes program. The platform is also adopted by Bangladesh, Ethiopia and Sri Lanka.

A model like this could help Brazilians who live in regions far from large centers and suffer from a lack of doctors.

According to a survey by the Brazilian Medical Association, while the national average is 2.6 physicians per thousand inhabitants, that of municipalities with up to 5,000 inhabitants is 0.3 physicians per thousand inhabitants.

The same survey showed that there are more doctors working for the private sector than for the SUS (Unified Health System). On the other hand, 80% of the Brazilian population depends exclusively on public health.

For Deborah Malta, professor of public health at UFMG (Federal University of Minas Gerais) and former coordinator of the Plan to Combat Chronic Diseases of the Ministry of Health, it is important that the professional be the same in all consultations. “The patient needs to be assisted by the clinician, have an early diagnosis and be recognized as being at risk. This follow-up must be done by the same team.”

According to her, the replacements of physicians at the posts undermine the standardization of treatment and alienate the patient. “Our biggest problem today is that hypertensive patients have access to care, but do not return. As hypertension is a silent disease, they end up abandoning medication and only come back when they have a crisis, which makes control difficult”, he adds.

In Chile, the problem was tackled by setting up facilities in small towns and rural areas. “They are managed by nursing technicians and paramedics, but a doctor goes there once a week or every 15 days. The important thing is that the care protocol is the same as in other facilities, as well as the medications available for basic care. “, explains Fernando Lanas, professor of medicine at Universidad de la Frontera and one of the Chilean references on the subject.

The geographic extension and the fact that 90% of its population is concentrated in urban areas weigh in favor of Chile — Brazil has a similar rate, but the size makes it difficult to install posts.

Furthermore, although there is a national care protocol in Brazil, physicians tend to follow different lines of treatment. At the same time, as part of the purchase of medicines is made by the municipalities, manufacturers can vary from city to city.

These differences are reflected in the rates for each country: Chile has one of the lowest mortality rates from cardiovascular disease on the American continent, according to PAHO (Pan American Health Organization).

The public policies of the last few decades were also essential for the country to have the lowest mortality rate from ischemic heart disease in the Americas in 2019 —the fifth country that most managed to reduce this index since 1990.

In recent years, Chile has also joined Hearts, a WHO program that tries to internationalize standards of care around the world. India and Brazil are also part of the initiative.

Despite the obstacles, the control and treatment of hypertension in Brazil has advanced a lot in recent decades, especially after the creation of Farmácia Popular in 2004.

“Today you can get a lot of medicine for free. Generics were also a great advance because they made medicines more accessible. A hypertension treatment costs a maximum of R$ 20 per month”, says Fernando Bassan, director of the National Institute of Cardiology.

According to PAHO, Brazil was the second American country that managed to control hypertension the most since 1990 —behind Canada. Today, 26% of the population is hypertensive, against more than 30% three decades ago.