IJCS | Volume 31, Nº3, May/ June 2018

256 Santos et al. Mortality due to hypertensive diseases in Brazil International Journal of Cardiovascular Sciences. 2018;31(3)250-257 Original Article compared to blacks, something that might have been influenced by eventual subjectivity in skin color identification and due to the predominance of miscegenation in Brazil. 19 There are still few studies conducted in South America on the higher prevalence of arterial hypertension in blacks, with most scientific information concerning ethnicity coming from studies carried out in the United States. 20 Several limitations arise from this type of study, which deals with aggregate data. For example, we cannot rule out the possibility of having occurred increased notifications, on the one hand, and hypertension control improvement, on the other hand, something that would generate an apparent constancy of the illness in the time series analysis of the data. However, from a methodological point of view, the research design sought to adjust the analysis for eventual influences of both temporal and geographic factors in the same region or state. It is also important to highlight that we used the data considered more relevant for the elaboration of public policies nowadays, something that reflects in the planning, execution and evaluation of health actions towards the combat of the diseases of greatest impact in Brazil. 21 Therefore, the implementation of Pharmaceutical Assistance by the Ministry of Health´s department has arisen as a major impact resource to reduce mortality due to non-transmitted chronic diseases, including arterial hypertension. 9 Nevertheless, based on the information available on mortality associated with hypertensive diseases in public registries, and by submitting these data to a complex evaluation, corroborated by several analytical models, the absence of major reduction in mortality rates in the period of five years suggests that it is necessary, among other measures, to broaden the pharmacological scope of free distribution drugs and enhance healthcare programs. Conclusion Death rates associated with hypertensive diseases were higher in the southeastern and northeastern Brazil, compared to the other regions. This rate did not show significant alterations between the years 2010 and 2014, when assessed in relation to the same state and region of Brazil. Other predictors of higher rates of mortality were brown skin color and increase in age. Public health policies, concerning medical care for hypertensive patients and prevention of complications, must be preferably applied in the states with the highest rates. Author contributions Conception and design of the research: Santos MAA. Acquisition of data: Santos MAA. Analysis and interpretation of the data: Santos MAA. Statistical analysis: Santos MAA. Writing of the manuscript: Santos MAA, Prado BS, Santos DMS. Critical revision of the manuscript for intellectual content: Santos MAA, Prado BS, Santos DMS. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associated with any thesis or dissertation work. Ethics approval and consent to participate This article does not contain any studies with human participants or animals performed by any of the authors. 1. Guimarães RM, Andrade SS, Machado EL, Bahia CA, Oliveira MM, Jacques FV. Regional differences in cardiovascular mortality transition in Brazil, 1980 to 2012. Rev Panam Salud Publica. 2015;37(2):83-9. 2. Andrade SS, Rizzato S, Scalioni A, Landmann C, Malta DC. Self- reported hypertension prevalence in the Brazilian population: analysis of the National Health Survey, 2013. Epidemiol Serv Saúde. 2015;24(2):297-304. 3. World Health Organization (WHO). Global status report on noncommunicable diseases. Geneva; 2014. 4. MalachiasMV, SouzaWK, Plavnik FL, Rodrigues CI, BrandãoAA, Neves MF, et al; Sociedade Brasileira de Cardiologia. 7a Diretriz Brasileira de hipertensão arterial. Arq Bras Cardiol. 2016;107(3 supl 3):1-83. 5. Thorpe RJ Jr, Bowie JV, Smolen JR, Bell CN, Jenkins ML Jr, Jackson J, et al. Racial disparities in hypertension awareness and management: are there differences among African Americans andWhites living in similar social and healthcare resource environments? EthnDis. 2014;24(3):269-75. 6. Judd SE, Kleindorfer DO, McClure LA, Rhodes JD, Howard G, Cushman M, et al. Self-report of stroke, transient ischemic attack, or stroke References