Profile of hypertensive and / or diabetic patients of a Basic Health Unit in Maranhão , Brazil

Objective: to know the profile of hypertensive and / or diabetic patients treated at a basic health unit in Maranhão. Method: This is a descriptive, retrospective study with a quantitative approach, performed in April 2018, with data from medical records of 137 patients enrolled in the HIPERDIA program. Data were collected through a structured script and tabulated using the SPSS SamplePower Software. Results: in the researched unit there were 195 registered patients, hypertensive and / or diabetic. A higher number of female hypertensive and / or diabetic patients was observed, with a higher prevalence of these pathologies in individuals Research, Society and Development, v. 9, n. 10, e6019108986, 2020 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v9i10.8986 3 between 60 and 69 years, followed by those aged between 50 and 59. The predominant weight among participants was between 60 and 69kg. The main blood pressure values found were <120/80 (45.99%) and with 140-159 / 90-99 (22.63%). Conclusion: weight gain is related to older age and it would be interesting to follow a nutritionist and a physical educator within the multiprofessional team in the basic health units, since both pathologies need weight control so that the rates remain stable. When prescribing medications, attention should be paid to protocols regarding the risks of drug interaction that exist among some antihypertensives.

between 60 and 69 years, followed by those aged between 50 and 59. The predominant weight among participants was between 60 and 69kg. The main blood pressure values found were <120/80 (45.99%) and with 140-159 / 90-99 (22.63%). Conclusion: weight gain is related to older age and it would be interesting to follow a nutritionist and a physical educator within the multiprofessional team in the basic health units, since both pathologies need weight control so that the rates remain stable. When prescribing medications, attention should be paid to protocols regarding the risks of drug interaction that exist among some antihypertensives.
Keywords: Hypertension; Diabetes Mellitus; Health of the elderly.

Introduction
The Family Health Strategy (FHS) is the main gateway to health prevention, promotion and recovery in Brazil. In order for the health problems of this strategy to have solutions, it is necessary to discover the real needs of its individuals, something that is possible when tracing the epidemiological profile of the population served and planning actions with scientifically based data (Nascimento & Joselma, 2019). Among the various consultations performed in the FHS, we highlight Diabetes Mellitus (DM) and Systemic Arterial Hypertension (SAH), which are prevalent and of increasing magnitude, often asymptomatic, which makes it difficult to start treatment and, consequently, can influence on sequels such as heart attack, stroke, among others. These two pathologies are among the top five causes of mortality in the world, in the elderly population, leading to decreased life expectancy (Francisco et al., 2019). In Brazil, these chronic non-communicable diseases have been causing an important economic impact, due to their capacity for morbidity and mortality.
Arterial hypertension and Diabetes Mellitus have as main treatment, changes in lifestyle, such as physical activity and healthy eating, in addition to preventive control of glucose and blood pressure (Dias et al., 2019). The inappropriate use of medications can contribute to the uncontrolling of these diseases, since the treatment is for long periods and the continuous maintenance of the prescription is as important as the change in lifestyle (Freitas et al., 2018).
In order to avoid such complications, early identification is essential and fundamental for promoting the health of these patients and for decreasing health problems, Research, Society and Development, v. 9, n. 10, e6019108986, 2020 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v9i10.8986 since routine monitoring at the Basic Health Unit (UBS) has reduced the number of hospitalizations and mortality due to these damages, since these patients are guided and "supervised" in relation to the use of medications and habits that can uncontrolled blood glucose and blood pressure rates.
Correlating the importance of prior identification of DM and SAH cases with successful treatment, the guiding question arises: What are the main peculiarities of hypertensive and / or diabetic patients seen at a basic health unit?
To answer this question, it is necessary to analyze specific traits of the studied population. Therefore, the objective of this research is to know the profile of hypertensive and / or diabetic patients treated at a basic health unit in Maranhão, Brazil.

Method
This is a descriptive, retrospective study, with a qualitative and quantitative approach. According to Shitsuka, Parreira & Shitsuka (2018), the qualitative method contributes significantly to the data collection plan, valuing the results of the study.
The study was carried out in a UBS on the outskirts of the city of Timon, in the state of Maranhão, Braszil, a municipality that currently has 57 family health teams.
The selection by the basic unit was made for convenience, given the accessibility of the researchers. Data were collected in April 2018, from the unit's nurse record book, after prior authorization. The researchers recorded the information collected carefully, in order to maintain the confidentiality and privacy of patient data.
The inclusion criteria were: records of the last visits of patients who were registered and followed up for hypertension and / or diabetes. The exclusion criteria were: incomplete records.
For data collection, a previously established script for organizing information was built. The variables surveyed were: sex, age group, body mass index (BMI), waist circumference (WC), blood pressure (BP) value and medications used by patients.
Remembering that data from the last visits of each patient were taken into account.
The data were tabulated using the SPSS SamplePower 3.0 software, for better organization and appreciated through descriptive analysis. Then, the data were expressed in graphs, for better visualization of the results.
Researches that have the objective of deepening the theory of situations that emerge spontaneously and contingently in professional practice, do not need registration in the CEP / Research, Society and Development, v. 9, n. 10, e6019108986, 2020 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v9i10.8986 6 CONEP system, as long as they do not reveal data that can identify the subject, as is the case of this research.

Results and Discussion
In the UBS surveyed, 195 patients were registered, between hypertensive and diabetic patients, or with both pathologies. Of the 137 patients selected from the inclusion and exclusion criteria, 88 (64.23%) were hypertensive, 20 (14.60%) had DM and 29 (21.17%) had both pathologies, with females prevailing in the three groups (Graph 1). It was observed that there is a greater number of female hypertensive and / or diabetic patients. This is due to the fact that women are considered more vulnerable than men when it comes to health-related changes, such as multiple diseases, obesity and, consequently, the use of multiple medications (DIAS et al., 2019). Most studies reinforce the prevalence of care among women. In a municipality in Pernambuco, a survey showed that the number of hypertensive patients registered in 2012 was 12,879, of which 67% were female and 1057 registered diabetics, 62% were women, according to the SUS Department of Informatics (2019). Another municipality in Pernambuco showed that of the 35,596 registered hypertensive patients, 65% were women (Lima, Gaia, & Ferreira, 2012 The study showed that, in the researched field, there is a higher prevalence of these pathologies in individuals aged between 60 and 69 years, followed by individuals aged between 50 and 59. This is explained by the fact that there is a higher prevalence in cases of hypertension in patients older than 50 years; it is stipulated that 65% of the elderly have this systemic pathology and is directly related to the most advanced age groups (Castro et al., 2019). Bearing in mind that it is proven that the patient who has one of these pathologies is more likely to develop the other (Fonsêca, 2018). Costa et al., (2020), evidenced in their research, a high number of individuals in the age group of 60 with hypertension and diabetes, which confirms the data of this research. It can be seen that the predominance of patients' weight was between 60 and 69 kg, followed by those with 50 to 59 kg. However, this data becomes more concrete when the Body Mass Index is applied, which allows to analyze the degree of overweight and obesity of the individual. Thus, 69 of the patients were weighing between ≥25 -≤30, which means that they were overweight.
The increased overweight index, verified in this study leads us to infer that it is necessary to carry out activities that encourage healthy habits for the patients of the UBS surveyed, considering that sedentary lifestyle is a risk factor for cardiovascular disease, as well as for SAH and DM (Castro et al., 2019). Research, Society and Development, v. 9, n. 10, e6019108986, 2020 (CC BY 4. It was observed that women who were followed up for SAH and / or DM were above the waist circumference stipulated by the Ministry of Health, while most of the men surveyed were within normal standards. Studies have shown that the value of increased abdominal circumference represents risks for the evolution of chronic diseases, especially cardiovascular diseases, dyslipidemia and glucose intolerance (Girotto, Andrade & Cabrera, 2010 We chose to specify the values of arterial hypertension due to the higher prevalence of hypertension in the basic unit. It is noted that despite the high number of individuals treating this pathology in the studied area, the blood pressure values of most of them are within the normal range, thus confirming the effectiveness of the attention directed to them, in this basic unit studied. The drugs most used by both sexes were hydrochlorothiazide (HCTZ), followed by captopril, glibenclamide, losartan, among others (Graph 7).
Graph 7 -Drugs used by hypertensive, diabetic or both pathological patients. April 2018. Some patients had up to four prescribed antihypertensive drugs, which calls attention to the need to reassess the client and his medication regimen. Another factor to note is that there were many patients using HCTZ and propranolol concomitantly, something that, according to the Brazilian Society of Cardiology (2010), can cause interaction and raise blood glucose levels.
Pharmacological therapies for the elderly require a certain amount of care when prescribed, since many patients use several medications a day, for the treatment of SAH or DM and other degenerative diseases resulting from old age, and the improper association of these drugs can cause drug interactions, toxic effects or adverse reactions.

Final Considerations
The findings showed the prevalence of female patients in routine consultations, alerting to actions that encourage and enable men's adherence to health services. It was also noticed that the weight gain is related to older age, a phase in which the metabolism decreases and it would be interesting to include the monitoring of a nutritionist and a physical educator, within the multiprofessional team in the basic health units, already that the two pathologies mentioned in the study, need weight control so that the rates remain stabilized. A weakness was observed when it comes to the prescription of medications, since the protocols regarding the risks of drug interaction, existing among some antihypertensive drugs, must be respected.
Early diagnosis alone is not enough to improve the pathological condition of hypertensive and diabetic patients. Identifying the profile of these patients seen at the UBS, in order to guide the development of preventive actions, such as monthly monitoring and follow-up, guidelines, lectures, conversation circles, among other promotion actions, is essential to minimize these problems.
The data analyzed in this study, made it possible to perceive the relevance of the routine monitoring of the HIPERDIA program, as well as the importance of annotating patient information in the medical record, at the time of the consultation, since, through these data, one can have a broader epidemiological view of assistance to these users and, from then on, improve the assistance model. The lack of some complete records implied the size of the final sample and consequently became a limiting factor in the study. At the same time, inconsistencies in the records pointed out important gaps for the health team's intervention.
In view of the difficulties encountered by researchers, with regard to patient data, new research is suggested that deals with the nursing record in primary care, since nursing notes and developments are of great value for gathering information that guide the public health actions.