Adesão ao tratamento da hipertensão arterial na população negra do maior quilombo urbano da América Latina

Abstract

Hypertension imposes a heavy burden in Brazil and disproportionately affects the black population, especially when social determinants and primary health care arrangements limit therapeutic continuity and blood pressure control. In this context, urban quilombo communities deserve attention because they combine geographical proximity to services with organizational microbarriers that impact the effectiveness of care. This study aimed to evaluate adherence to antihypertensive treatment in black people living in an urban quilombo. This is a cross-sectional, analytical study with a quantitative approach, conducted at a health center in an urban quilombo in São Luís, Maranhão, Brazil; the sample consisted of 288 registered users diagnosed with hypertension who self-identified as black. Two instruments were used for data collection: the first on sociodemographic profile, lifestyle, and health, and the second related to adherence to hypertension treatment. Descriptive analyses and multivariate models were used to estimate associations between adherence scores and blood pressure control. The results of the survey showed that the majority were women (69.4%) and elderly (51%), with low education (46%) and income (87.1%); overweight was frequent (63.3%). A very high proportion of adherence was observed according to the instrument applied (98.6%), but a substantial portion maintained blood pressure above the recommended clinical target (52.4%); in addition, higher adherence scores were associated with lower diastolic blood pressure levels, while the effect on systolic blood pressure was less consistent. These findings suggest that medication use alone are not sufficient to ensure optimal blood pressure control when other conditions that impact blood pressure levels persist. Self-reported adherence may be high and still coexist with suboptimal blood pressure control; continued access and care bonding showed potential to increase adherence; however, social determinants and lifestyle also continue to significantly influence the clinical response, thereby primary care professionals, when considering strategies to improve adherence, need to combine these aspects with care arrangements for the effective control of hypertension.