ABC | Volume 115, Nº2, August 2020

Original Article Jardim et al. Real-world team-based care for HTN Arq Bras Cardiol. 2020; 115(2):174-181 BP control rate in the study population was 68%, and this value was higher when only non-diabetic patients were considered (79%). On the other hand, assessing exclusively diabetic patients, BP control rate dropped to 37.9%. Figure 1 shows a summary of BP control rates in our study. Individuals with BP under control were more likely to be females, older, with longer follow-up periods and lower BMI when compared to those with uncontrolled BP. Additionally those with controlled BP were less likely to be obese, diabetic and sedentary in comparison to those without BP controlled. Characteristics of the study population, stratified by BP control, are presented in Table 2. The multivariable logistic regression model built to identify variables independently associated to BP control in this population showed that diabetes was inversely associated with BP control while age ≥ 60 years and female sex were directly associated (Table 3). Discussion We assessed data of more than 1,500 hypertensive patients with regular follow-up in a team-based care center to show the results of this multidisciplinary therapeutic strategy in a real-world setting. All patients included in this study were referred to a center specialized in hypertension treatment and had their treatment fully covered by Brazil’s universal health system. Additionally, baseline characteristics of the patients were similar to those reported in the Brazilian Registry of Hypertension, 20 showing the generalizability of the results of the study. Almost 70% of the all patients had their BP controlled, and those results went up to 79% considering only the non-diabetic patients. BP control was inversely associated with diabetes and directly associated with age ≥ 60 years and female sex. Population studies conducted in Brazil showed that BP control rates varied from 10.1% to 57.6% depending on country region and patient characteristics. 21 None of these studies, however, used data from team-based care centers. Our overall control rate (68%) was higher than those reported in conventional treatments in Brazil. As compared to BP control rates reported in other middle income countries like South Africa (30 and 49%), 22,23 and even in a high-income country like the United States of America (48%), 24 in the current study, we found better results with a team-based intervention. BP control in patients with HTN and diabetes is challenging; control rates are usually lower than the ones found in hypertensive patients without diabetes. 25 Also, diabetic hypertensive patients are more likely to develop resistant hypertension. 26 Only 37.9% of our diabetic hypertensive patients had their BP under control as opposed to the 79% control rate among the non-diabetic patient. Additionally, diabetes was independently and inversely associated to BP control in this team-based care setting. Older ages have been associated to BP control in different populations. 22,27 Our results reinforce these findings since we found that age ≥ 60 years was directly associated to BP control. Besides that, the novelty of our findings is the association between older ages and BP control in a team- based care strategy. Figure 1 – Blood pressure control in the overall study population, non-diabetics and diabetics. Goiânia – Brazil. Blood pressure control – BP < 140 x 90 mmHg in non- diabetics and < 130 x 80 mmHg in diabetics. 177