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Behavior, Psychology and Sociology

Hidden barriers: obesity bias in hypertension treatment

International Journal of Obesity volume 48, pages 1506–1512 (2024)Cite this article

Subjects

Abstract

Background and objectives

Individuals with obesity often face obesity bias, which may influence the delivery of appropriate medical care. Our aim is to evaluate the adequacy of therapeutic decisions regarding the pharmacological treatment for hypertension in patients with diabetes, both with and without obesity.

Methods

This is a multicentric cross-sectional study of patients with type 2 diabetes and arterial hypertension who received outpatient care in Southern Brazil. Participants were stratified into two groups according to their body mass index (BMI): lower weight (BMI < 25.0 kg/m2) and with obesity (BMI ≥ 30.0 kg/m2). The primary outcome evaluated was the difference in pharmacological treatment decisions for hypertension between groups, considering individualized hypertension targets from American Diabetes Association (ADA), European Society of Hypertension (ESH), and European Society of Cardiology (ESC) guidelines. Data were analyzed as a binary endpoint (failure to receive treatment intensification vs. receiving treatment intensification when necessary) and groups were compared using multivariable logistic regression.

Results

This study included 204 participants, of which 53 were at a lower weight and 151 had obesity. Patients with obesity more frequently failed to receive appropriate treatment intensification when compared to individuals with lower weight. The differences between the study groups were observed when considering the blood pressure target of three societies: ESH (adjusted OR 2.28 [95% CI 1.12–4.63], p = 0.022), ESC (adjusted OR 2.13 [95% CI 1.05–4.31], p = 0.035), and ADA (adjusted OR 2.33 [95% CI 1.13–4.77], p = 0.021).

Conclusion

These findings suggest that patients with obesity may face potential disparities in hypertension management, and obesity status may be related to therapeutic inertia in the management of arterial hypertension in this group.

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Fig. 1
Fig. 2: Treatment decisions for pharmacological treatment of arterial hypertension according to individualized blood pressure targets.

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Data availability

The data collected for the study will be available for one year after publication of the article upon justified request to the email address of the main researcher and with a signed data access agreement.

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Funding

This work was conducted with support from Research Incentive Fund (FIPE/HCPA), Postgraduate Program in Endocrinology Health Sciences at the Universidade Federal do Rio Grande do Sul, School of Medical Sciences at the Pontifícia Universidade Católica do Rio Grande do Sul and Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul. This study was funded in part by the Coordination for the improvement of Higher Education Personnel – Brazil (CAPES) - Finance Code 001.

Author information

Authors and Affiliations

  1. Medicine and Health Sciences Graduate Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil

    Guilherme Heiden Telo, Lucas Friedrich Fontoura, Janine Alessi & Gabriela Heiden Telo

  2. Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil

    Guilherme Heiden Telo

  3. School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil

    Lucas Strassburger Matzenbacher, Georgia Oliveira Avila, Vicenzo Gheno, Maria Antônia Bertuzzo Brum, Julia Belato Teixeira, Isadora Nunes Erthal, Janine Alessi & Gabriela Heiden Telo

  4. The Postgraduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

    Josiane Schneiders & Beatriz D. Schaan

  5. Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil

    Beatriz D. Schaan

  6. General Internal Medicine Division, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil

    Janine Alessi

Authors
  1. Guilherme Heiden Telo
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  2. Lucas Strassburger Matzenbacher
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Contributions

GHT and J.A: Conceptualization, Methodology, Data curation, Writing- Original draft preparation. L.S.M: Methodology, Writing- Original draft preparation, Formal Analysis. L.F.F, J.B.T, I.N.E, V.G. M.A.B.B., G.D.O.A, J.S: Methodology, Writing- Original draft preparation. B.D.S: Supervision, Writing- Reviewing and Editing. G.H.T.1,3: Conceptualization, Supervision, Writing- Reviewing and Editing. All authors have reviewed the final version of the manuscript and agree with the publication of the results presented. GHT is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding author

Correspondence to Gabriela Heiden Telo.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

The study was approved by the Research Ethics Committee (REC) of Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (No. 3.803.681), REC of Hospital de Clinicas de Porto Alegre (No. 2016-0286), and in the Basic Health Unit of IAPI and Family Health Strategy of IAPI (approved by the National Health Council in accordance with resolution 466/12 and by the Porto Alegre Municipal Health Office). All authors signed the confidentiality document for data usage.

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Telo, G.H., Matzenbacher, L.S., Fontoura, L.F. et al. Hidden barriers: obesity bias in hypertension treatment. Int J Obes 48, 1506–1512 (2024). https://doi.org/10.1038/s41366-024-01613-4

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