P1947Trends in prevalence, mortality and morbidity associated with high systolic blood pressure in Brazil from 1990 to 2017: estimates from the Global Burden of Disease 2017 study
Authors: Ribeiro A L P , Brant L C C , Yadgir S , Oliveira G M M , Glenn S D , Mooney M , Naghavi M , Duncan B B , Passos V M , Silva D A S , Roth G A , Nascimento B 
Published: October 2019

Abstract

Background
Hypertension remains the leading risk factor for cardiovascular disease worldwide. In Brazil, a third of adults have hypertension. The prevalence and impact of this risk factor on disease burden in Brazil and its federal units should be assessed in order to better address the issue.

Objective
To describe trends in prevalence and burden of diseases attributable to high systolic blood pressure (HSBP) among Brazilians ≥25 years old according to sex and federal units using the Global Burden of Disease (GBD) 2017 estimates.

Methods
We used the comparative risk assessment developed for the GBD study to estimate trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALY), by sex, and federal units for HSBP from 1990 to 2017. This study included 14 HSBP-outcome pairs that met the GBD study criteria for evidence of causation. HSBP was defined as ≥140mmHg for prevalence estimates and, to evaluate the burden of HSBP, a theoretical minimum risk exposure level (TMREL) of 110–115 mmHg was considered. We estimated the portion of deaths and DALYs that could be attributed to HSBP. We also explored the drivers of trends in attributable burden of HSBP, as well as the relation of HSBP burden and sociodemographic development.

Results
In Brazil, the prevalence of HSBP is 18.9 (95% uncertainty intervals [UI] 18.5 to 19.3%) and the age-standardized death rate attributable to HSBP decreased from 189.2 (95%UI 168.5 to 209.2) deaths to 104.8 (95%UI 94.9 to 114.4) deaths per 100,000 from 1990 to 2017. In spite of that, the total number of deaths attributable to HSBP increased 53.4% and HSBP raised from 3rd to 1st position, as the leading risk factor for deaths during the period. Regarding total DALYs, HSBP raised from 4th in 1990 to 2nd cause in 2017 - in the last, only behind smoking. The main driver in the change of HSBP burden in Brazil is population aging. Across federal units, the reduction in the age-standardized death rates attributable to HSBP are heterogeneous and the greater reduction correlated to higher sociodemographic development.

Conclusions
The age-standardized death and DALY rates attributable to HSBP are decreasing in Brazil, probably as results of successful public health policies for primary prevention and control of HSBP. However, the reduction was more significant in federal units with higher sociodemographic development, suggesting that the effect of health policies was heterogeneous. Moreover, HSBP has become the main risk factor for death in the country, mainly due to population aging. As such, the Brazilian health system should increase investments in policies to address the situation and prepare itself to cope with higher burden of HSBP in the near future.

Acknowledgement/Funding
The GBD 2017 Brazil study is primarily funded by the Bill & Melinda Gates Foundation