ABC | Volume 113, Nº4, October 2019

Original Article Santiago et al. Prevalence of hypertension and associated factors Arq Bras Cardiol. 2019; 113(4):687-695 Table 1 – Distribution of systemic arterial hypertension according to demographic and socioeconomic characteristics in adults from the semi‑arid region, state of Pernambuco, Brazil, 2015 Systemic arterial hypertension Variables n % 95%CI p-value ‡ Gender 0.358 Male 44 30.1 22.8 – 38.3 Female 70 25.9 20.8 – 31.6 Age (years) 0.000 § 20 – 29 13 10.6 05.7 – 17.4 30 – 39 20 15.9 10.0 – 23.4 40 – 49 25 36.8 25.4 – 49.3 50 – 59 56 56.6 46.2 – 66.5 Ethnicity 0.721 White 26 28.9 19.8 – 39.4 Multiracial or black 88 27.0 22.3 – 32.2 Schooling 0.000 § Never studied 66 44.6 36.4 – 53.0 Primary school 32 19.5 13.7 – 26.4 High school/university 16 15.4 09.1 – 23.8 Employment status 0.150 Works 45 23.9 18.0 – 30.7 Does not work 69 30.3 24.4 – 36.7 Place of residence Urban area 65 27.0 21.5 – 33.0 0.816 Rural area 49 28.0 21.5 – 35.3 Economic class 0.001 Upper or middle * 45 20.5 15.3 – 26.4 Lower † 69 35.2 28.5 – 42.3 95%CI: 95% confidence interval; * classes A1, A2, B1, B2, C1, and C2; † classes D and E; ‡ Pearson’s chi-square test; § chi-square test for trend. Body composition is another important aspect related to hypertension, especially with regard to fat distribution, as the increase in visceral adipose tissue is directly associated with a greater incidence of the disease. 26 One of the limitations of the present study was not evaluating body fat distribution based on more accurate methods, such as the quantification of visceral or subcutaneous adipose tissue using computed tomography. 27 However, studies report that indicators such as BMI and WC are good tools to use in population-based studies and increases in these measures are associated with a higher risk of developing hypertension. 28-30 The positive association between overweight based on BMI and hypertension in the semi-arid region of Pernambuco underscores the need for more effective dietary and nutritional education programs derived from health promotion policies and actions, in addition to greater encouragement to practice physical activity. Strategies of this nature would have a higher impact on the process of nutritional transition that has affected the country 31 and culminated in a 26.3% increase in overweight between 2006 and 2016, according to a telephone survey conducted by the Brazilian Ministry of Health. 32 The concomitant occurrence of hypertension and reduced glucose tolerance and/or DM supports the scientific evidence indicating the close link between these conditions, which often develop together and through the same metabolic pathways. 33 An analysis of the Brazilian National Household Surveys conducted in 1998, 2003, and 2008 shows an increase from 1.7 to 2.8% in the prevalence coefficient standardized by gender and age range for DM associated with hypertension in the period, especially in the northeast and midwest regions of the country. 34 These data further highlight the considerable problems these conditions represent, especially in regions such as Northeastern Brazil and mesoregions such as the semi-arid region. 690