Trends in Prevalence of Hypertension in Brazil: A Systematic Review with Meta-Analysis

<div><h3>Background</h3><p>The prevalence of hypertension in emerging nations was scarcely described to date. In Brazil, many population-based surveys evaluated the prevalence in cities throughout the country. However, there is no population-based nationwide study of prevalence of hypertension. In this study, we estimated the prevalence of hypertension for the country and analyzed the trends for the last three decades.</p> <h3>Methods</h3><p>Cross-sectional and cohort studies conducted from 1980 to 2010 were independently identified by two reviewers, without language restriction, in the PubMed, Embase, LILACS, and Scielo electronic databases. Unpublished studies were identified in the Brazilian electronic database of theses and in annals of Cardiology congresses and meetings. In total, 40 studies were selected, comprising 122,018 individuals.</p> <h3>Results</h3><p>Summary estimates of prevalence by the former WHO criteria (BP≥160/95 mmHg) in the 1980’s and 1990’s were 23.6% (95% CI 17.3–31.4%) and 19.6% (16.4–23.3%) respectively. The prevalence of hypertension by the JNC criteria (BP≥140/90 mmHg) in the 1980’s, 1990’s and 2000’s were 36.1% (95% CI 28.7–44.2%), 32.9% (29.9–36.0%), and 28.7% (26.2–31.4%), respectively (P<0.001). In the 2000’s, the pooled prevalence estimates of self-reported hypertension on telephone inquiries was 20.6% (19.0–22.4%), and of self-reported hypertension in home surveys was 25.2% (23.3–27.2%).</p> <h3>Conclusions</h3><p>The prevalence of hypertension in Brazil seems to have diminished 6% in the last three decades, but it still is approximately 30%. Nationwide surveys by self-reporting by telephone interviews underestimate the real prevalence. Rates of blood pressure control decreased in the same period, corresponding currently to only one quarter of individuals with hypertension.</p> </div

Source, year, sample size and methodological aspects of the 40 studies included in meta-analysis (in alphabetical order of first author).

<p>Source, year, sample size and methodological aspects of the 40 studies included in meta-analysis (in alphabetical order of first author).</p

Map of Brazil according to its five macro-regions with the cities comprehended in the meta-analysis.

<p>Map of Brazil according to its five macro-regions with the cities comprehended in the meta-analysis.</p

Prevalence of hypertension, according to the JNC criteria, by decade.

<p>Prevalence of hypertension, according to the JNC criteria, by decade.</p

Flowchart of records retrieved, screened and included in the systematic review.

<p>Flowchart of records retrieved, screened and included in the systematic review.</p

Regression of first year of data collection on logit prevalence rate according to the JNC criteria.

<p>Regression of first year of data collection on logit prevalence rate according to the JNC criteria.</p

Prevalence of hypertension, according to the JNC criteria, by Brazilian macro-region in the 2000’s.

<p>Prevalence of hypertension, according to the JNC criteria, by Brazilian macro-region in the 2000’s.</p

Effect of diacerein on renal function and inflammatory cytokines in participants with type 2 diabetes mellitus and chronic kidney disease: A randomized controlled trial

<div><p>Diacerein seems to improve metabolic control and reduce inflammatory marker levels in individuals with type 2 diabetes mellitus (Type 2 DM), but for participants with chronic kidney disease (CKD) its effect is unknown. This study aimed to evaluate the effect of diacerein <i>vs</i>. placebo on urinary albumin/creatinine ratio (ACR), glomerular filtration rate (GFR), and inflammatory cytokines in type 2 DM participants with CKD. Blood pressure (BP) and metabolic control were secondary outcomes. This randomized, placebo-controlled, parallel trial of adjuvant treatment of type 2 DM with diacerein enrolled seventy-two participants with CKD, aged 30–80 years, with glycated hemoglobin levels from 53–97 mmol/mol (7.0–11.0%), receiving angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and antidiabetic agents. Participants randomized to diacerein or placebo were followed-up up to 90 days. Both groups had a marked reduction in ACR, but there was no effect on glomerular filtration rate. While the diacerein group had reduced TNF-α levels at the 75th percentile with a borderline significance (P = 0.05), there were no changes in the IL levels at the 75^th percentile.</p><p>Diacerein prevented the increase in blood glucose to the level observed in the placebo group (P = 0.04), improving metabolic control by 74%, reducing 24-hour diastolic BP, nighttime systolic and diastolic BP compared to the placebo group. In conclusion, among patients with type 2 DM and CKD, diacerein does not have an effect on ACR or GFR, but slows metabolic control deterioration and is associated with lower nighttime systolic and diastolic blood pressure.</p><p><b>Trial registration:</b> Brazilian Clinical Trials Registry (Registro Brasileiro de Ensaios Clinicos; ReBeC) <a href="http://www.ensaiosclinicos.gov.br/rg/edit/2510/" target="_blank">U1111-1156-0255</a></p></div

Changes in adipokines according to randomization group (mean ± SE).

<p>Changes in adipokines according to randomization group (mean ± SE).</p

Baseline characteristics of participants according treatment group [Mean ± SD or n (%) or median (interquartile range)].

<p>Baseline characteristics of participants according treatment group [Mean ± SD or n (%) or median (interquartile range)].</p