Avaliação de fatores psicossociais no controle pressórico de pacientes hipertensos durante a pandemia de COVID-19 / Evaluation of psychosocial factors in the pressure control of hypertensive patients during the pandemic of COVID-19

Leonardo Hosken Dornellas, Gabriella Carolyna Alves Vieira, João Pedro Domingos Nakamura Baba, Lucas Peixoto Sudério, Matheus Lavigne Marinho, Patrick Dias Albano Ramos, Pedro Humberto Gomes de Freitas, Vinícius Gustavo de Carvalho Moura, Vitor Peghin da Silva, Henrique Oswaldo da Gama Torres, Fausto Aloísio Pedrosa Pimenta

Abstract


Objetivos: avaliar adesão ao tratamento, controle da pressão arterial (PA) e variáveis psicossociais em indivíduos hipertensos, antes e durante a pandemia de COVID-19. Métodos: estudo de coorte prospectiva com 96 adultos hipertensos para analisar as variáveis (instrumentos): sociodemográficas (entrevista); impacto psicológico da pandemia (questionário IES-R); sintomas de estresse, ansiedade e depressão (questionário EADS-21); adesão ao tratamento farmacológico (questionário BMQ); e controle da pressão arterial (medidas de PA). Para comparar escore BMQ e controle da PA foi utilizado o teste de McNemar’s, já para avaliar associação entre as variáveis: teste qui-quadrado, exato de Fisher, teste T e Mann-whitney. Resultados: houve significativa redução do controle pressórico com início da pandemia (McNemar's qui-quadrado=12,565, p=0.00567) e os fatores de risco associados foram: raça branca (OR=7,765; IC 95%=1,474–40,903, p=0,016), escolaridade menor que quatro anos (OR=7,531, IC 95%=1,200–47,258, p=0,031) e menos horas diárias dedicadas a assuntos relacionados à pandemia (OR=3,852, IC 95%=1,287–11,526, p=0,016). Nível reduzido de sintomas depressivos foi identificado como fator protetor contra descontrole da PA (OR=0,130, IC 95%=0,24 – 0,681, p = 0,018). Não houve variação significativa na adesão ao tratamento medicamentoso (McNemar's chi-squared=4.8979, p=0.557). Conclusão: a pandemia de COVID-19 aumentou a taxa de PA descontrolada, mas não comprometeu adesão ao tratamento.


Keywords


adesão à medicação, COVID-19, depressão, hipertensão, inquéritos e questionários, saúde mental

References


WHO coronavirus disease (COVID-19) dashboard. Geneva: World Health Organization, 2020 - [cited 2021 Mar 18]. Available from: https://covid19.who.int/

Orellana JDY, Cunha GMD, Marrero L, Moreira RI, Leite IDC, Horta BL. Excesso de mortes durante a pandemia de COVID-19: subnotificação e desigualdades regionais no Brasil [Excess deaths during the COVID-19 pandemic: underreporting and regional inequalities in Brazil]. Cad Saude Publica. 2021 Feb 5;37(1):e00259120. Portuguese. doi: 10.1590/0102-311X00259120. PMID: 33566992. http://europepmc.org/article/MED/33566992

Freitas CM, Silva IVM, Cidade NC. COVID-19 AS A GLOBAL DISASTER: Challenges to risk governance and social vulnerability in Brazil. Ambiente Soc. 2020;23. doi: https://doi.org/10.1590/1809-4422asoc20200115vu2020L3ID. https://www.scielo.br/j/reeusp/a/TkQMY6gqJnXwpRzkGQN8V6P/?format=pdf

Almeida WDS, Szwarcwald CL, Malta DC, Barros MBA, Souza Júnior PRB, Azevedo LO, Romero D, Lima MG, Damacena GN, Machado ÍE, Gomes CS, Pina MF, Gracie R, Werneck AO, Silva DRPD. Changes in Brazilians' socioeconomic and health conditions during the COVID-19 pandemic. Rev Bras Epidemiol. 2021 Jan 6;23:e200105. Portuguese, English. doi: 10.1590/1980-549720200105. PMID: 33439938. https://www.fcm.unicamp.br/covid/cientificos/changes-brazilians-socioeconomic-and-health-conditions-during-covid-19-pandemic

Zhang Y, Ma ZF. Impact of the COVID-19 Pandemic on Mental Health and Quality of Life among Local Residents in Liaoning Province, China: A Cross-Sectional Study. Int J Environ Res Public Health. 2020 Mar 31;17(7):2381. doi: 10.3390/ijerph17072381. PMID: 32244498; PMCID: PMC7177660. https://europepmc.org/article/MED/32468155

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington 2013. http://www.niip.com.br/wp-content/uploads/2018/06/Manual-Diagnosico-e-Estatistico-de-Transtornos-Mentais-DSM-5-1-pdf.pdf

World Health Organization. Adherence to long-term therapies: evidence for action. Geneva: World Health Organization; 2003. https://www.who.int/chp/knowledge/publications/adherence_full_report.pdf?ua=1

Ben AJ, Neumann CR, Mengue SS. The Brief Medication Questionnaire and Morisky-Green test to evaluate medication adherence. Rev Saude Publica. 2012 Apr;46(2):279-89. English, Portuguese. doi: 10.1590/s0034-89102012005000013. Epub 2012 Feb 14. PMID: 22331180. https://pubmed.ncbi.nlm.nih.gov/22331180/

IBGE (Fundação Instituto Brasileiro de Geografia e Estatística), 2012. Censo Demográfico, 2010. Rio de Janeiro: IBGE. https://www.ibge.gov.br/

Caiuby AV, Lacerda SS, Quintana MI, Torii TS, Andreoli SB. Adaptação transcultural da versão brasileira da Escala do Impacto do Evento-Revisada (IES-R) [Cross-cultural adaptation of the Brazilian version of the Impact of Events Scale-Revised (IES-R)]. Cad Saude Publica. 2012 Mar;28(3):597-603. Portuguese. doi: 10.1590/s0102-311x2012000300019. PMID: 22415191. https://www.scielo.br/j/csp/a/KjGRgShSYWMYNkbsKfTqHvB/

Duarte YAO. Família: rede de suporte ou fator estressor. A ótica de idosos e cuidadores familiares [tese]. São Paulo (SP): Universidade de São Paulo; 2001. https://repositorio.usp.br/single.php?_id=001242861&locale=pt_BR

Vignola RC, Tucci AM. Adaptation and validation of the depression, anxiety and stress scale (DASS) to Brazilian Portuguese. J Affect Disord. 2014 Feb;155:104-9. doi: 10.1016/j.jad.2013.10.031. Epub 2013 Oct 28. PMID: 24238871. https://pubmed.ncbi.nlm.nih.gov/24238871/

Matsudo S, Araújo T, Matsudo V, Andrade D, Andrade E, Oliveira C, et al. Questionário Internacional de Atividade Física (IPAQ): estudo de validade e reprodutibilidade no Brasil. Rev Bras Ativ Fís Saúde. 2001;6(2):5-12. https://rbafs.emnuvens.com.br/RBAFS/article/view/931

Dean AG, Arner TG, Sunki GG, Friedman R, Lantinga M, Sangam S, Zubieta JC, Sullivan KM, Brendel KA, Gao Z, Fontaine N, Shu M, Fuller G, Smith DC, Nitschke DA, Fagan RF. Epi Info™, a database and statistics program for public health professionals. CDC, Atlanta, GA, USA, 2011. https://www.cdc.gov/epiinfo/index.html

Malachias MV. 7th Brazilian Guideline of Arterial Hypertension: Presentation. Arq Bras Cardiol. 2016 Sep;107(3 Suppl 3):0. doi: 10.5935/abc.20160140. PMID: 27819379; PMCID: PMC5319461. https://pubmed.ncbi.nlm.nih.gov/27819380/

Portela PP, Mussi FC, Gama GGG, Santos CA de ST. Fatores associados ao descontrole da pressão arterial em homens. Acta Paul Enferm. 2016;29:307–15. https://www.scielo.br/j/ape/a/gJzYhs3WCjGGt54FyfHQDpn/?lang=pt

Almeida ALC, Santo TMDE, Mello MSS, Cedro AV, Lopes NL, Ribeiro APMR, Mota JGC, Mendes RS, Almeida PAA, Ferreira MA, Arruda DM, Santos AAP, Rios VG, Dantas MRN, Silva VA, Silva MGD, Sampaio PHS, Guimarães AR, Santos EG Jr. Repercussions of the COVID-19 Pandemic on the Care Practices of a Tertiary Hospital. Arq Bras Cardiol. 2020 Nov;115(5):862-870. English, Portuguese. doi: 10.36660/abc.20200436. PMID: 32965397; PMCID: PMC8452210. https://pubmed.ncbi.nlm.nih.gov/32965397/

Dyer O. Covid-19: Pandemic is having "severe" impact on non-communicable disease care, WHO survey finds. BMJ. 2020 Jun 3;369:m2210. doi: 10.1136/bmj.m2210. PMID: 32493728. https://pubmed.ncbi.nlm.nih.gov/32493728/

Noblat ACB, Lopes MB, Lopes AA. Raça e lesão de órgãos-alvo da hipertensão arterial em pacientes atendidos em um ambulatório universitário de referência na cidade de Salvador. Arq Bras Cardiol. 2004;82:111–5. https://www.scielo.br/j/abc/a/Q9xwLMtFT3BrpX4mKTB8wyS/

Singh GM, Danaei G, Pelizzari PM, Lin JK, Cowan MJ, Stevens GA, Farzadfar F, Khang YH, Lu Y, Riley LM, Lim SS, Ezzati M. The age associations of blood pressure, cholesterol, and glucose: analysis of health examination surveys from international populations. Circulation. 2012 May 8;125(18):2204-2211. doi: 10.1161/CIRCULATIONAHA.111.058834. Epub 2012 Apr 4. PMID: 22492580; PMCID: PMC4174463. https://pubmed.ncbi.nlm.nih.gov/22492580/

Tavares NU, Bertoldi AD, Mengue SS, Arrais PS, Luiza VL, Oliveira MA, Ramos LR, Farias MR, Pizzol TD. Factors associated with low adherence to medicine treatment for chronic diseases in Brazil. Rev Saude Publica. 2016 Dec;50(suppl 2):10s. doi: 10.1590/S1518-8787.2016050006150. PMID: 27982378; PMCID: PMC5157921. https://pubmed.ncbi.nlm.nih.gov/27982378/

Remondi FA, Cabrera MAS, Souza RKT de. Não adesão ao tratamento medicamentoso contínuo: prevalência e determinantes em adultos de 40 anos e mais. Cad Saúde Pública. 2014;30:126–36. https://www.scielo.br/j/csp/a/89w4bykTcKBwFLZRcSJ8cTF/?format=pdf

Fonseca F de CA, Coelho RZ, Nicolato R, Malloy-Diniz LF, Silva Filho HC da. A influência de fatores emocionais sobre a hipertensão arterial. J Bras Psiquiatr. 2009;58:128–34. https://www.scielo.br/j/jbpsiq/a/CKrxBnS4hMw3dztH9mdjJpJ/

Brito DC, Marsicano EO, Grincenkov FR, Colugnati FA, Lucchetti G, Sanders-Pinheiro H. Stress, coping and adherence to immunosuppressive medications in kidney transplantation: a comparative study. Sao Paulo Med J. 2016 Jul-Aug;134(4):292-9. doi: 10.1590/1516-3180.2015.01071008. Epub 2015 Dec 8. PMID: 26648278. https://pubmed.ncbi.nlm.nih.gov/26648278/

Mello AF, Juruena MF, Pariante CM, Tyrka AR, Price LH, Carpenter LL, Del Porto JA. Depressão e estresse: existe um endofenótipo? [Depression and stress: is there an endophenotype?]. Braz J Psychiatry. 2007 May;29 Suppl 1(0 1):S13-8. doi: 10.1590/s1516-44462007000500004. PMID: 17546342; PMCID: PMC4467732. https://www.scielo.br/j/rbp/a/yfF9MB4BBkff4WmkW9QFsNh/?format=pdf

Modell S, Lauer CJ, Schreiber W, Huber J, Krieg JC, Holsboer F. Hormonal response pattern in the combined DEX-CRH test is stable over time in subjects at high familial risk for affective disorders. Neuropsychopharmacology. 1998 Apr;18(4):253-62. doi: 10.1016/S0893-133X(97)00144-9. PMID: 9509493. https://pubmed.ncbi.nlm.nih.gov/9509493/

Beutel ME, Klein EM, Brähler E, Reiner I, Jünger C, Michal M, Wiltink J, Wild PS, Münzel T, Lackner KJ, Tibubos AN. Loneliness in the general population: prevalence, determinants and relations to mental health. BMC Psychiatry. 2017 Mar 20;17(1):97. doi: 10.1186/s12888-017-1262-x. PMID: 28320380; PMCID: PMC5359916. https://pubmed.ncbi.nlm.nih.gov/28320380/

Theeke LA. Sociodemographic and health-related risks for loneliness and outcome differences by loneliness status in a sample of U.S. older adults. Res Gerontol Nurs. 2010 Apr;3(2):113-25. doi: 10.3928/19404921-20091103-99. Epub 2010 Apr 20. PMID: 20415360. https://researchrepository.wvu.edu/cgi/viewcontent.cgi?article=3601&context=etd

Leigh-Hunt N, Bagguley D, Bash K, Turner V, Turnbull S, Valtorta N, Caan W. An overview of systematic reviews on the public health consequences of social isolation and loneliness. Public Health. 2017 Nov;152:157-171. doi: 10.1016/j.puhe.2017.07.035. Epub 2017 Sep 12. PMID: 28915435. https://pubmed.ncbi.nlm.nih.gov/28915435/

Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, Rubin GJ. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020 Mar 14;395(10227):912-920. doi: 10.1016/S0140-6736(20)30460-8. Epub 2020 Feb 26. PMID: 32112714; PMCID: PMC7158942. https://pubmed.ncbi.nlm.nih.gov/32112714/




DOI: https://doi.org/10.34119/bjhrv5n3-099

Refbacks

  • There are currently no refbacks.