Prevalence: Mean values for prevalence of hypertension in 18 selected populations, varied between 15.7% (BP greater than or equal to95 mm Hg) and 27.7% (BP greater than or equal to 90 mm Hg). In three Mail surveys in Salvador (n = 5093 volunteers), prevalence mean value was 33.7% (JNC VI criteria), being influenced by age (5.5 to 17.8% and 41.0 to 54.9% for the 25-34 and 55-59 year old age groups, respectively) and socioeconomic class (24.7 and 39.6% for the highest and lowest social class, respectively, OR = 0.50 (0.260.95, P = 0.023). The national prevalence by the Ministry of Health is 20%. Mortality and morbidity: Mortality as a consequence of morbidity has increased, with stroke being a leading cause of death (11.3% of total deaths, 10.1% of all deaths in the 20-59 year-old age group, and 33.9% of cardiovascular deaths in Brazilian Capitals, 1994). Cardiovascular risk factors: At comparable age groups, prevalence of other major cardiovascular risk factors are: smoking similar to27%, total cholesterol greater than or equal to200 mg/dI similar to32.5%, glucose intolerance similar to8.0%, diabetes similar to7.5%, BMI 25-29 similar to29.1%, BMI greater than or equal to 30similar to9.6%, and physical inactivity similar to92%. Awareness, treatment, and control: Data are very scarce. In the total Mail population (n = 4613) in Salvador, a high blood pressure was present in 24.4% of those who either denied hypertension or ignored blood pressure. Of those who reported to be hypertensives, only 34.5% had their blood pressure <140/90 mm Hg. In a national inquiry including 2519 physicians, 88% would start treatment with drug monotherapy, diuretics (53%), and angiotensin-converting enzyme inhibitor (ACEI) (24%). If blood pressure control is not achieved, 55% will combine with another drug (diuretic + ACEI (46%) or + beta-blocker (24%)), and 33% will increase the dosage. Nonpharmacological treatment would be prescribed for every patient by 17% of the physicians, while 62% would prescribe it for 25% of their patients. Adhesion is better for pharmacological (60%) than for nonpharmacological treatment (8%). Final remarks: Three Consensus Documents (the most recent in 1998), the creation of the Department of Hypertension Leagues, the Fighting Hypertension National Day, the Confederation of Hypertensive Patients Associations, and the very recent launch of the National Plan for Reorganization of Hypertension and Diabetes Care are some measures being taken in a joint effort of the Ministry of Health and the Brazilian Societies of Cardiology, Hypertension and Nephrology, to strengthen and improve the fight against hypertension.
