Hypertense individuals assisted in secondary care service: cardiovascular risk and social determinants of health

Abstract Background In the perspective of the social determinants of health, Systemic Arterial Hypertension presents complex multifactorial nature. This cardiovascular risk factor is influenced by behavioral, economic, social, political and environmental aspects. Objective To investigate the relationship between social determinants of health and global cardiovascular risk in hypertensive patients assisted in the secondary care service of the Unified Health System. Method An analytical sectional study with patients from Centro Hiperdia in Northern Minas Gerais, Brazil. Data of social determinants were collected through a structured questionnaire. The classification of cardiovascular risk (high, moderate and low) was based on clinical data. The statistic considered significance level 5%. Results Among 231 participants, the majority (64.1%) presented high cardiovascular risk, associated with clinical data: high systolic blood pressure (p=0.04) and longer diagnostic time (p=0.01). High cardiovascular risk was associated with social determinants: satisfaction with access to health services (p=0.02) and healthy physical environment (p=0.02). Conclusion Although satisfaction with the health services and the physical environment presented reversed results, we suggest the strengthening of health care policies and practices that recognize different determinants, and prevent the severity of cardiovascular risk.

背景 从健康社会决定因素（social determinants of health）视角出发，系统性动脉高血压（Systemic Arterial Hypertension）具有复杂的多因素致病特性。该心血管危险因素受行为、经济、社会、政治与环境等多维度因素影响。
目的 探讨巴西统一卫生系统（Unified Health System）二级医疗服务中接诊的高血压患者，其健康社会决定因素与整体心血管风险之间的关联。
方法 本研究为分析性横断面研究，研究对象为巴西米纳斯吉拉斯州北部高血压诊疗中心（Centro Hiperdia）的患者。通过结构化问卷收集健康社会决定因素相关数据；心血管风险分层（高、中、低）依据临床数据完成；本研究设定显著性水平为5%。
结果 纳入的231名研究对象中，多数（64.1%）存在高心血管风险，该风险与两项临床指标相关：收缩压升高（p=0.04）及确诊时长更长（p=0.01）；同时与两项健康社会决定因素相关：对医疗服务可及性的满意度（p=0.02）及健康物理环境状况（p=0.02）。
结论 尽管对医疗服务的满意度与物理环境状况呈现反向关联结果，本研究建议应强化兼顾各类决定因素的医疗保健政策与实践，以预防心血管风险的加重。