Racial and gender inequities in the control of arterial hypertension in ELSA-Brasil: An intersectional approach

This study investigated the association of the intersectional categories of gender-race/color with inadequate blood pressure (BP) control in Brazilian adults using antihypertensive drugs to treat hypertension. This is a crosssectional analysis conducted with 4448 participants living with hypertension from visit 2 (2012-2014) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) undergoing pharmacological treatment. The association of the intersectional categories - White woman, Brown woman, Black woman, White man, Brown man, Black man - with inadequate BP control (systolic BP levels >= 140 mmHg and/or diastolic BP levels >= 90mmH) was estimated by the prevalence ratio (PR) and 95% confidence interval (95% CI) obtained by generalized linear models with Poisson distribution, adjusted covariates. The age-standardized prevalence of inadequate BP control ranged from 18.9% (White women) to 35.6% (Black men). After adjusting for sociodemographic characteristics, health-related behavior, health conditions, and the class number of antihypertensive medications, compared to White women, Black men (PR: 1.49 95% CI: 1.26-1.75), Brown men (PR: 1.42 95% CI: 1.18-1.72), Black women (PR: 1.36 95% CI: 1.12-1.65), and White men (PR: 1.32 95% CI: 1.09-1.60) showed poorer BP control. Results corroborate a higher prevalence of inadequate BP control in Black and Brown men. Furthermore, this intersectional approach evidenced that the prevalence of inadequate BP control in Black women is higher than that in White men, when compared to White women. Findings highlight that, for the development of more equitable BP control strategies, one must consider the specificities of socially marginalized intersectional groups, especially Black men and women.