Author(s): Rene Jorge Mena Mujica*, Ana Ivis Estrada Casteleiro, Elisa Maria Puentes Rizo and Pedro Rolando López Rodríguez
Introduction: Hypertension is one of the most frequent chronic diseases in Cuba. In our country the prevalence is 70% and is proportional to the years of life. More than 30% of the adult population suffers from it, causing high morbidity and mortality.
Objective: To describe the main risk factors in women with arterial hypertension of the doctor’s office 2 of the Párraga health area in the year 2021.
Methods: An epidemiological, observational, descriptive and cross-sectional study was carried out in a universe of 153 female patients with arterial hypertension. Sociodemographic and epidemiological variables were studied.
Results: 39.8% corresponded to patients between 41 and 50 years old, with a weight above the normal value in 40.5% d. 62 women did not finish high school and the most frequent toxic habit was coffee consumption in 69.3 %. More than 70% are heavy consumers of and salt. 58 patients had a history of medication intake, prevailing the intake of non-steroidal anti-inflammatory drugs in 18.3%.
Conclusions: The age group of 41 to 50 years prevailed, with unfinished secondary school level and housewives, a high percentage of them is above the ideal weight and coffee intake, smoking, salt consumption and the previous intake of medications continue to behave as the main risk factors in the disease.
Arterial hypertension (HTN) is the main risk factor for the global burden of morbidity and mortality and it is estimated that it causes more than half of the annual deaths attributed to cardiovascular diseases,constituting one of the main risk factors related to mortality from non-communicable diseases in Cuba [1,2]. A large proportion of these conditions and the premature deaths they cause can be avoided through measures aimed at controlling modifiable risk factors, such as reducing or eliminating tobacco use and improving health education aimed at controlling risk factors [3]. Between 20 and 30% of the world population suffers from AHT, so it is estimated that by 2025 there will be 1.5 billion people diagnosed with this condition and the detection and control of risk factors continues to be the strategy essential to prevent them [4,5]. In the American continent, about 140 million people suffer from hypertension, of which between 8 and 30% live in Latin America and the Caribbean. It is estimated that over the next 10 years there will be 20.7 million deaths from cardiovascular disease, of which some 2.4 million will be attributable to hypertension in the Americas region [6]. At the end of 2019, heart diseases continued to be the main cause of death in Cuba, occupying the first place with 26,736 deaths for a rate of 238.1 per 100,000 inhabitants and within these, ischemic diseases were the ones with the highest frequency and, secondly, hypertensive [7].In studies carried out on the subject, a series of risk factors related to this disease are described, such as: stress, obesity, sedentary lifestyle, smoking, diet (rich in saturated fats and salt), skin color, heredity, diabetes mellitus and hypercholesterolemia [8].For its part, the estrogen deficiency that occurs in women after menopause has also been related to an increase in cardiovascular risk [9]. In fact, the National Cholesterol Education Program recognizes postmenopausal status as a risk factor for cardiovascular disease, assigning it the same weight as being male [10]. According to the statistics indicated, the high frequency of arterial hypertension constitutes a real health problem in Cuba and according to theexperience of the authors of this study, it has been possible to verify that there is no adequate and homogeneous response on the part of hypertensive patients in relation to knowledge about the importance of preventing risk factors, hence the importance of research that will allow an approach to the knowledge of the way in which they influence the disease of our patients.
An epidemiological, observational, descriptive and cross-sectional study was carried out with the objective of characterizing the main risk factors of Arterial Hypertension in hypertensive women belonging to the clinic # 2 of the Párraga Polyclinic in the year 2021. Empirical methods were used (observation, questionnaire and surveys), theoretical (analysis and synthesis, historical - logical, induction and deduction) and statistics that collected, analyzed, interpreted and presented all the information through frequency measurements. The universe consisted of 153 women over 18 years of age diagnosed with essential hypertension and who met the inclusion criteria of residing in the health area at the time the research was carried out, who agreed to participate and who was psychologically fit. The sample matches the universe. It was explained to each of them that the results obtained in the research would be used for their presentation in scientific events and biomedical journals, and they could leave the event at any time they so requested. Sociodemographic and clinical variables were defined: age, nutritional status, schooling, toxic habits, salt intake and previous medication intake. The primary data was obtained from a questionnaire prepared by the authors. The texts and tables were processed in Microsoft Word. For the analysis and discussion of the results, descriptive statistics were preferably used, which allowed reaching the objectives of the work and reaching its final conclusions. The results were expressed through absolute numbers and percentages and represented in statistical tables.
| Age Grupos | Quantity | % |
|---|---|---|
| Less Than 20 | 1 | 0,65 |
| 21-30 | 3 | 1,96 |
| 31-40 | 9 | 5,88 |
| 41-50 | 61 | 39,86 |
| 51-60 | 42 | 27,45 |
| 61 and over | 37 | 24,18 |
| Total | 153 | 100,00 |
Sourse; Survey
The age group from 41 to 50 years prevailed with 61 patients for 39.86% followed by the group from 51 to 60 with 27.45%. The leading level was reached from the age of 40.
| Nutritional Condition | Number | % |
|---|---|---|
| Underweight | 12 | 7,84 |
| Normal Weight | 79 | 51,63 |
| Overweight | 43 | 28,10 |
| Obese | 19 | 12,41 |
| Total | 153 | 100,0 |
Source: Survey
The table above shows that 43 patients, 28.1% of all hypertensive women, have a weight above the normal value and 79 patients (51.63%) have adequate weight. Only 12 patients (7.84%) had poor nutritional status.
| Education | Quamtity | % |
|---|---|---|
| illiterate | 2 | 1,31 |
| UnfinishedElementary School | 3 | 1,96 |
| Primary Finished | 10 | 6,53 |
| High School notfinished | 62 | 40,52 |
| Unfinishedpre-university | 25 | 16,33 |
| University | 6 | 3,92 |
| Total | 153 | 100,0 |
Source: Survey
In table number 3 it is observed that the highest percentage of the women under study have not completed secondary education, representing 40.52% of the total, only 6 (3.92%) are university students and if we add the values of primary studies unfinished, finished and illiterate, a value of 9.8% is reached.
| Habits | Number | % |
|---|---|---|
| Smoking | 47 | 30,7 |
| Coffee Intake | 106 | 69,3 |
| No Habit | 0 | 0 |
| Total | 153 | 100,0 |
Source: Survey
The table above expresses, in relation to toxic habits, that the most frequent is coffee consumption with 69.3% and smoking with 30.7% of the total number of patients studied. About a third of all women smoke and coffee intake appears in more than 70%.
| Habits | Number | % |
|---|---|---|
| Normal saltconsumers | 22 | 30,7 |
| Excessive salt intake | 131 | 69,3 |
| Total | 153 | 0 |
Source: Survey
It can be seen that 85.6% of our patients are heavy salt consumers, despite the etiological role of salt consumption in the development of hypertension.
| Medications | Number | % |
|---|---|---|
| Non-steroidalanti-inflamatory | 28 | 18,3 |
| Steroids | 3 | 1,9 |
| Tricyclicantidepressants | 13 | 8,5 |
| Oral contraceptives | 14 | 9,15 |
| Total | 58 | 38,0 |
Source: Survey n= 153
Table 6 shows the distribution according to previous intake of medications that act as a risk factor for hypertension, 58 (38.0%) patients had a history of taking one or another medication, with the intake of non-steroidal anti-inflammatory drugs prevailing in 18.3%, almost double that of oral contraceptives, which constituted 9.15% of the total.
In the research carried out, from 40 years of age the risk of suffering from hypertension increases in the women studied. Studies confirm this result, mainly due to the loss of elasticity of the large arteries and an increase in vasoconstrictor stimuli potentiated by the increase in the thickness of the middle layer and the ventricular mass [11]. Most of our patients were in the group between 41 and 50 years old and followed by hypertensive women between 51 and 60 years old, coinciding with a study published by Hechavarria, who found that as age increased, so did the number of hypertensive patients. García, in an investigation with similar characteristics, found that 51.06% of the patients were between 40 and 59 years old, which is related to what was found in our study, and for his part, Martínez published that in their casuistry, the most frequent ages of hypertensive patients corresponded to adults over 60 years of age, which does not coincide with our results. A considerable number of the women under study were overweight or obese, this being considered a primary risk factor in hypertension. A significant reduction in overweight and obesity could have prevented, in one year, the death of 3,789 Cubans, 2,511 women and 1,278 men; 940 diabetic patients, 821 people diagnosed with cancer in the locations that were explored, and 2,024 deaths in people with cardiovascular disease [12-15]. According to the III risk survey carried out in Cuba (16), overweight and obesity in global terms are increasing in the Cuban population and especially in women. In a study carried out in Mexico by Iñigo Riesgo et al., 33% of overweight and 30% of obesity are reported, for 63% of excess weight in women and Sunchao reports 66.4% in the Polyclinic “;April 19”;, values higher than the one found in our study, but Most of the patients that make up the study have not finished secondary education and almost a tenth of them did not finish primary studies or are illiterate. Monterrey agrees with these findings, but other authors conclude that there is no significant relationship between level of schooling and adherence to treatment [16-21]. It is considered that patients with completed pre-university and university studies have a higher level of knowledge and have a greater perception more realistic of the risk that this disease implies [19]. Coffee consumption, together with smoking, constituted the most frequent toxic habits in the patients studied. Numerous studies show the risk that these constitute in hypertension and identify them as modifiable factors related to unhealthy lifestyles [22-25]. Coffee consumption raises systolic and diastolic blood pressure figures up to 14 and 10 mm/Hg respectively with the daily consumption of 2 to 4 cups of coffee and it has been shown that smoking is a factor involved in the etiopathogenesis of essential hypertension and determines a worse prognosis in hypertensive patients A large proportion of cardiovascular diseases and deaths as a result of these can be avoided if risk factors are controlled and in the diet, reducing salt intake may be the greatest contributor to prevention [26-30]. Excessive consumption of sodium plays an important role in hypertension, since salt is considered one of the most harmful precursors, producing changes in the fibrocytes between smooth muscle cells, causing the accumulation of collagen in the arterial walls and as a consequence decrease in elasticity is presented [31,32]. It can also be associated with decreased kidney function caused by aging, which causes sodium retention and therefore an increase in circulatory volume [33]. It is known that the most unnoticed adverse drug reactions are not the ones that produce a disease, but those that cause worsening of a disease already treated [34]. In a study on potentially inappropriate prescriptions in older adults carried out in the municipality of San Miguel del Padrón in Havana,it was found that the pharmacological group most used in treatment was non-steroidal anti-inflammatory drugs, which coincides with our results [35,36].
Arterial hypertension was more frequent in patients aged 41-50 years with a secondary school level and with a weight above normal value. Among the toxic habits found, ingestion of coffee was the most frequent and excessive consumption of salt appears in the largest number of patients studied. The previous intake of medications was not frequent, being the consumption of nonsteroidal anti-inflammatory drugs the one that prevailed. Conflicts of Interest: The authors declare no conflicts of interest.
