A prevalência de fatores de risco cardiovascular, com destaque para a hipertensão arterial tem mostrado tendência presente e ascendente em populações indígenas. O objetivo principal desse estudo foi comparar o perfil de fatores de risco cardiovascular, com destaque para hipertensão arterial, em indígenas Mura da área rural e urbana do município de Autazes, Amazonas. Casuística e Métodos: Estudo transversal, realizado no município de Autazes no estado do Amazonas com 455 indígenas da etnia Mura (234 indígenas da área rural e 221 da área urbana). Os participantes foram caracterizados em relação a variáveis sociodemográficas, hábitos e estilos de vida, condições de saúde, perfil antropométrico, perfil lipídico e glicemia de jejum. A pressão arterial foi avaliada pela medida casual, com aparelho automático validado. Hipertensão foi definida para valores 140 e/ou 90 mmHg ou diagnóstico prévio de hipertensão.Avaliou-se os fatores associados a hipertensão arterial, por meio da regressão de Poisson com variância robusta, sendo considerados estatisticamente significativos, valores de p0,05. Resultados: A maioria era do sexo feminino (57,8%), a média de idade foi de 42,2(16,7) anos, analfabetismo e ensino fundamental incompleto (58,0%), morando com companheiro (73,5%). A prevalência de hipertensão nos indígenas Mura foi de 26,6% (IC95% 22,5-30,7), menor entre os da área rural (21,8% vs 31,7%,p0,05). Os indígenas Mura da área rural foram diferentes (p0,05) dos indígenas da área urbana, respectivamente, em relação a: idade menos elevada [40,5(16,5) vs 43,7(16,8) anos)]; estado civil amasiado (58,2% vs 33,4%); renda familiar menorque três salários (43,6% vs 51,6%); mais trabalho temporário (61,5% vs 47,1%); venda mais elevada de produtos agropecuários e da pesca (53,4% vs 30,3%); pertencentes a classe econômica D e E (97,8% vs 74,2%). Em relação às características antropométricas, os indígenas da área rural foram diferentes (p0,05) dos da área urbana, respectivamente, para: IMC menos elevado [25,7(4,1) vs 27,6(5,2) kg/m²]; presença de obesidade (15,8% vs 35,3%); circunferência da cintura aumentada substancialmente (8,5% vs 42,1%); relação cintura quadril aumentada (81,2% vs 89,1%); percentual de gordura corporal muito alta (32% vs 48,8%); gordura visceral alto (17,1% vs 25,3%). Quanto aos hábitos e estilos de vida, os indígenas da área rural foram diferentes (p0,05) dos da área urbana em relação ao: menor índice de tabagismo com 11 anos ou mais (46,5% vs 62,0%); maior índice de: etilismo (57,3% vs 22,2%), sedentarismo (17,1% vs 11,3%)]. Quanto o modo de preparo dos alimentos, os indígenas da área rural se diferenciaram (p0,05) dos da área urbana, respectivamente, quanto à maior: utilização do método da cocção (81,2% vs 72,8%); adição de sal nas refeições prontas (58,1% vs 43,9%) e utilização de açúcar (100% vs 97,7%). Em relação à hipertensão arterial, os indígenas da área rural foram diferentes (p0,05) dos da área urbana, respectivamente, quanto à: menor prevalência de hipertensão referida (12,8% vs 28,1%); receberam menos orientações para tratamento não medicamentoso (18,2% vs 55,8%); deixaram de comparecer às consultas marcadas por falta de dinheiro (68,4% vs 25,0%); tinham dificuldade para realizar o tratamento medicamentoso por esquecimento (85,0% vs 14,3%). Quanto aos antecedentes familiares de doenças cardiovasculares, os indígenas da área rural referiram menos (p0,05): problemas de coração (28,6% vs 34,8%), acidente vascular encefálico (22,6% vs 34,8%), diabetes mellitus (26,0% vs 45,7%), dislipidemias (25,6% vs 43,9%) e de hipertensão arterial (57,7% vs 72,4%). Em relação aos antecedentes pessoais, os indígenas da área rural foram diferentes (p0,05) ao referirem ausência: de problemas de coração (63,7% vs 72,4%), de acidente vascular encefálico (99,1% vs 94,1%), de diabetes mellitus (62,0% vs 83,3%) e de dislipidemias (56,0% vs 60,3%). Os indígenas hipertensos foram estatisticamente diferentes dos indígenas não hipertensos, respectivamente, em relação a: idade mais elevada [53,6(16,6) vs 37,9(14,4) anos]; analfabetismo e ensino fundamental incompleto (71,0% vs53,3%); viver sem companheiro (60,3% vs 77,2%); renda familiar menor que três salários (57,1% vs 44,0%); tinham menos trabalho remunerado temporário (46,3% vs 57,5%); menos benefício de programa social (43,8% vs 66,2%); aposentados (43,0% vs 20,4%). Os indígenas hipertensos foram diferentes (p0,05) dos indígenas não hipertensos por apresentarem a maior elevação: do IMC [28,9(5,0) vs 25,8(4,3) kg/m²], de obesidade (40,5% vs 19,8%), da circunferência do pescoço aumentada (75,2% vs 54,8%); da circunferência da cintura aumentada substancialmente (28,1% vs 21,9%), da relação cintura quadril aumentada (95,0% vs 81,4%), índice de conicidade mais elevado [1,32(0,05) vs 1,25(0,07)], gordura visceral muito alto (55,4% vs 34,7 gordura corporal muito alto (22,3% vs 5,7%); músculo esquelético baixo (45,0% vs 25,1%). Apresentaram ainda: triglicérides alto (30,6% vs 16,8%); colesterol alto (16,5% vs 6,0%); diabetes mellitus (6,6% vs 1,8%). Quanto aos hábitos de vida, os indígenas hipertensos referiram menos (p0,05): tabagismo (12,4% vs 23,4%), utilização de pílula ou hormônio anticoncepcional (15,1% vs 26,8%, p0,05). Eram mais praticantes de atividades físicas regulares (50,4% vs 46,1%). Quanto à alimentação, os indígenas hipertensos foram diferentes (p0,05) quanto à menor aquisição de alimentos da caça e/ou pesca (48,8% vs 68,3%), menor utilização de óleo vegetal (96,7% vs 99,7%) e adição de sal nas refeições prontas (43,0% vs 54,2%), porém utilizava mais gordura animal ou banha para o preparodos alimentos (12,7% vs 5,1%). Os indígenas hipertensos foram diferentes (p0,05) dos indígenas não hipertensos por apresentarem respectivamente mais história pregressa: de problemas de coração (14,9% vs 3,6%), de ocorrência de acidente vascular encefálico (9,1% vs 1,2%), ter diabetes mellitus (12,4% vs 2,4%) e ter tido e/ou ainda possuir dislipidemias (29,2% vs 9,6%).O fator de risco não modificável associado à hipertensão foi a idade [RP ajustada = 1,04 (IC95% 1,03-1,05)]. Entre os fatores modificáveis associaram-se à hipertensão: o IMC [RP ajustada = 1,07 (IC95%1,05-1,10)], os triglicerídeos classificados como limítrofe [RP ajustada = 1,68 (IC95% 1,19-2,38)] e alto [RP ajustada = 1,47 ( IC95% 1,06-2,04)], antecedente pessoal de dislipidemia [RP ajustada = 1,50(IC95% 1,09-1,94)], preparo de alimentos com gordura animal [RP ajustada = 1,89(IC95% 1,30-2,74)] e com gordura vegetal animal [RP ajustada = 0,36(IC95% 0,26-0,51)]. Conclusão: A prevalência de hipertensão foi alta, ainda se observou sinais de mudanças de hábitos e estilos de vidas, semelhantes à população não indígena. / The prevalence of cardiovascular risk factors, highlighting the arterial hypertension, has shown current and ascendant trend in Indian samples. The main objective of this study was to compare the profile of cardiovascular risk factors, emphasizing the arterial hypertension, of Mura ethnicitys Indians from rural and urban zones in Autazes, Amazon. Casuistic and Methods: cross-sectional research conducted in Amazon state with 455 Indians from the Mura ethnicity (234 Indians from rural zone and 221 from urban zone). We characterized the sample regarding sociodemographic variables, habits and lifestyle, health status, anthropometric profile, fat levels, and fasting glucose.Blood pressure was assessed trough casual measure with a validated automatic device.Hypertension was defined when blood pressure was 140 and/or90 mmHg or face a previous medical diagnosis of it.Poisson Regression with robust variance was applied to assess the factors associated with arterial hypertension. P values 0,05 were considered statistically significant. Results: Most of sample was complained for women (57,8%), with mean age of 42,2(16,7) years, Illiteracy and incomplete basic education (58,0%) and living with a partner (73,5%). The prevalence of hypertension in the Mura Indians was of 26,6% (95% CI 22,5-30,7), lower among those from rural zone (21,8% vs 31,7%, p0,05). The Mura Indians from rural area were different (p0,05) of those from urban ones regarding to: early age [40,5(16,5) vs43,7(16,8) years)]; cohabitating marital status (58,2% vs 33,4%); family income lower than 3 minimum wages (43,6% vs 51,6%); extra temporary work (61,5% vs 47,1%); increased selling of agricultural and fishing products (53,4% vs 30,3%); and pertaining the economic classesD and E (97,8% vs 74,2%). Concerning the anthropometric features, the Indians from rural area were different (p0,05) of those from urban zones, respectively, for: lower IMC [25,7(4,1) vs 27,6(5,2) kg/m²]; presence of obesity (15,8% vs 35,3%); substantially increasedwaist circumference (8,5% vs 42,1%); increased waist-hip ratio (81,2% vs 89,1%); very high Fat body percentage (32,0% vs 48,8%); high visceral fat (17,1% vs 25,3%). About habits and lifestyle, Indians from the rural zone showed difference (p0,05) to the other group regarding: lower index of smoking- 11 years or more (46,5% vs 62,0%); higher index of alcoholism (57,3% vs 22,2%); and sedentary lifestyle (17,1% vs 11,3%)]. The use of cooking method (81,2% vs 72,8%); extra salt in ready meals (58,1% vs 43,9%) and sugar intake (100% vs 97,7%) were different between the groups. In relation to arterial hypertension, both groups had differed (p0,05) in respect of: lower prevalence of referred hypertension (12,8% vs 28,1%); poorly guided about non-pharmacological treatment (18,2% vs 55,8%); absence in medical consultation due to lack of money (68,4% vs 25,0%); and difficulty to attend the pharmacological therapy due to forgetting (85% vs 14,3%). About the family background on heart diseases, the Indians from rural zone reported less (p0,05): heart diseases(28,6% vs 34,8%), brain stroke (22,6% vs 34,8%), diabetes mellitus (26,0% vs 45,7%), dyslipidemias (25,6% vs 43,9%) andarterial hypertension (57,7% vs 72,4%). The personal antecedents of rural Indians were different (p0,05) in the absence of: heart diseases (63,7% vs 72,4%), brain stroke (99,1% vs 94,1%), diabetes mellitus (62,0% vs 83,3%) and dyslipidemias (56,0% vs 60,3%). Hypertensive Indians were statistically different from the healthy ones regarding to: advanced age [53,6(16,6) vs 37,9(14,4) years]; Illiteracy and incomplete basic education (71,0% vs 53,3%); single marital status (60,3% vs 77,2%); family income less than three minimum wages (57,1% vs 44,0%); less temporary paid labor (46,3% vs 57,5%); less social programs benefits (43,8% vs 66,2%); retired (43,0% vs 20,4%). The group(hypertensive) differed by presenting increased: BMI [28,9(5,0) vs 25,8(4,3) kg/m²], obesity (40,5% vs 19,8%), neck circumference (75,2% vs 54,8%); waist circumference (28,1% vs 21,9%), hip-waist ratio (95,0% vs 81,4%), conicity index [1,32(0,05) vs 1,25(0,07)], visceral fat (55,4% vs 34,7),body fat (22,3% vs 5,7%); and poor skeletal muscle (45,0% vs 25,1%). They also presented: high levels of triglycerides (30,6% vs 16,8%); high cholesterol levels (16,5% vs 6,0%); and diabetes mellitus (6,6% vs 1,8%). Concerning life habits, hypertensives Indians referred less: smoking (12,4% vs 23,4%) and use of contraceptive pill or hormones (15,1% vs 26,8%, p0,05). They practice more regular physical activities than the non-hypertensive individuals (50,4% vs 46,1%). Hypertensive Indians were different on nutrition, regarding to: lower acquisition of hunting and fishing foods (48,8% vs 68,3%), lower use of vegetal oil (96,7% vs 99,7%) and higher salt addition in ready meals (43,0% vs 54,2%). However, they use more animal fat or lard for foods preparation (12,7% vs 5,1%). These hypotensive Indians had also more previous antecedents of: heart diseases (14,9% vs 3,6%), brain stroke occurrence (9,1% vs 1,2%), diabetes mellitus (12,4% vs 2,4%) and presence or historic of dyslipidemias (29,2% vs 9,6%).The unchangeable risk factor associated to hypertension was age [PR adjusted = 1,04 (95% CI1,03-1,05)]. The following changeable risk factors associated to the outcome were: BMI [PR adjusted= 1,07 (95% CI1,05-1,10)], border [PR adjusted = 1,68 (95% CI1,19-2,38)] and high [PR adjusted = 1,47 (95% CI1,06-2,04)] levels of triglycerides, personal records of dyslipidemia [PR adjusted = 1,50(95% CI1,09-1,94)], food preparation with animal [PR adjusted = 1,89(95% CI1,30-2,74)] and animal-vegetal fats [PR ajusted = 0,36(95% CI0,26-0,51)]. Conclusion: Hypertension was highly prevalent and the signs of lifestyles and habits changes were similar to those found in non-Indian population.

This research explored several adaptations to tuberculosis among the Indian population of Saskatchewan from 1926 to 1965 in order to demonstrate that this was an era in which disease played an significant role in the lives of the Indians. A broad ecological model' allowed for a variety of interactions to be explored. Within this framework, the study examined: the epidemiology and ecology of tuberculosis in the Saskatchewan Indian population; the development of health services to the Indians and the role of health services in the ecology of disease in this population; and the individual Indians' hospitalization and tuberculosis experience.<P> The epidemic of tuberculosis among the Indians of Saskatchewan began in the early 1880s. Rapidly assuming epidemic proportions, the death rate from tuberculosis among the Qu'Appelle Indians peaked in 1886 at a rate of 9,000 per 100,000. The death rate declined gradually after 1890 through the acquisition of population resistance and the elimination of the non-resistant families. The acute phase of the tuberculosis epidemic, characterized by extra-pulmonary disease in which the majority of cases terminated in a few months, lasted about two decades. Between 1907 and 1926, with gradually improving living conditions, continued acquisition of population resistance, but without application of any specific anti-tuberculosis measures, the death rate fell to 800 per 100,000.<p> Tuberculosis was endemic in the Saskatchewan Indian population by the beginning of the 1930s. Once endemic, the decline of the tuberculosis death rate continued to the end of the 1940s, without application of any specific anti-tuberculosis measures. By the time that specific measures were introduced, the death rate had declined to 417 per 100,000 in 1949. With the introduction of BCG vaccination and antimicrobial drug treatment, by 1959 the death rate declined to 39 per 100,000.<p> By the early 1960s tuberculosis mortality was successfully controlled in Saskatchewan, although death rates remained 15 times higher among the Indians. Tuberculosis morbidity continued to be a problem into the 1980s. In 1984, the incidence of tuberculosis was 21 times greater among the Indians than the corresponding rate in the non-Indian population.<p> Various environmental and cultural factors contributed to the Indian population's experiences with tuberculosis. The most important factor was the absence of population immunity. In addition, concentration of the population on reserves, the occurrence of intercurrent epidemics, sudden and dramatic dietary change, and lifestyle factors such as housing, sanitation and personal hygiene all contributed to incredibly high tuberculosis mortality in this population. The effect of medical care on the epidemiology of tuberculosis in the Saskatchewan Indians was not even considered in the preliminary analysis of the epidemic, because throughout the first several decades of the epidemic, no organized health services existed for the Indians.<p> In Saskatchewan, before World War II, medical services to the Indians were characterized by occasional surveys, the employment of part-time physicians, and health education through the distribution of circulars to Indian agents on health-related issues. Organized anti-tuberculosis programs which were developed in the years following the Second World War, in a large part, account for the dramatic decrease in the tuberculosis death rate in the province through the decade of the 1950s.<p> In the late 1940s, and throughout the 1950s and 1960s, most active Indian tuberculosis cases diagnosed in Saskatchewan were hospitalized for treatment. At least 10% of the Indian population of Saskatchewan received Indian hospital or sanatorium treatment throughout the first decade that those services were available to them.<p> Interviews conducted with fourteen Indian individuals who had been hospitalized for tuberculosis treatment provided two dichotomous perspectives on tuberculosis. Several individuals feared tuberculosis because of their familiarity with it in their families and on their reserves, however, most said that they knew tuberculosis, but they did not fear it. In terms of their knowledge about tuberculosis from a biomedical perspective, most had some idea of its symptomology although its specific etiology was not known. Most of the people interviewed appeared to understand the infectious nature of tuberculosis, however, their concern for their families may have stemmed from observations that tuberculosis was "in" particular families, not necessarily because they thought they could "give" tuberculosis to them. In terms of a perspective on the treatment of tuberculosis, most of the individuals interviewed were aware that hospital treatment was necessary. Archival sources and government annual reports, indicated that many Indians took a very active role in attending to their health needs. None of the individuals who were interviewed refused to go to the sanatorium, except for one woman who ran away several times. Most, however, planned their escape time after time. This suggests that their stay in the sanatorium and hospital may not have been of their own volition.<p> The most common and recurring theme that emerged from the interviews about life in the sanatoria or Indian hospital revolved around the structured, regimented nature of the treatment. Several individuals remembered quite vividly seeing other patients confined in strait jackets and body casts and distinctly remembered how strict the staff was with children.<p> While they were hospitalized, all of the individuals who were interviewed knew several other people who were being treated at the same time who were also their contemporaries from their own or surrounding reserves. All of the individuals also made several lasting friendships with people that they met while in the sanatorium. In addition, all, except for one young boy, were visited frequently by their families and friends. This indicates that the Indian people interviewed were not "isolated" from their families and friends for the duration of their treatment. Hospitalization, for those interviewed, was not a traumatic event because they had an extensive social network which enabled them to cope with the experience. In addition, because of the poor living conditions on many Indian reserves, a trip to the sanatorium or Indian hospital was a relief for some. Indian children in the sanatorium and hospital were given new clothes, toys, and books, and in some cases an education; things they did not get at home. One woman chose to remain in the sanatorium after her treatment regimen ended so that she could complete her education, something she could not do back at home in the north. Only one individual suggested that the experience was instrumental in determining the direction his future took.<p> In demonstrating that this was an era in which disease played a major role in the lives of the Indians, the epidemiology of tuberculosis in this population illustrated the pervasive influence that tuberculosis had on demographic and biological aspects of the population. The history of health services illustrated the role of medical intervention in the ecology of tuberculosis in this population. As a probe for behaviourial adaptations to disease on the individual level, the interviews contributed a human dimension to the study. To complete the picture of the role of disease in the lives of the Indians, the examination of the final component in adaptation, behaviourial adaptation to disease at the cultural level, is recommended.

This research explored several adaptations to tuberculosis among the Indian population of Saskatchewan from 1926 to 1965 in order to demonstrate that this was an era in which disease played an significant role in the lives of the Indians. A broad ecological model' allowed for a variety of interactions to be explored. Within this framework, the study examined: the epidemiology and ecology of tuberculosis in the Saskatchewan Indian population; the development of health services to the Indians and the role of health services in the ecology of disease in this population; and the individual Indians' hospitalization and tuberculosis experience.<P> The epidemic of tuberculosis among the Indians of Saskatchewan began in the early 1880s. Rapidly assuming epidemic proportions, the death rate from tuberculosis among the Qu'Appelle Indians peaked in 1886 at a rate of 9,000 per 100,000. The death rate declined gradually after 1890 through the acquisition of population resistance and the elimination of the non-resistant families. The acute phase of the tuberculosis epidemic, characterized by extra-pulmonary disease in which the majority of cases terminated in a few months, lasted about two decades. Between 1907 and 1926, with gradually improving living conditions, continued acquisition of population resistance, but without application of any specific anti-tuberculosis measures, the death rate fell to 800 per 100,000.<p> Tuberculosis was endemic in the Saskatchewan Indian population by the beginning of the 1930s. Once endemic, the decline of the tuberculosis death rate continued to the end of the 1940s, without application of any specific anti-tuberculosis measures. By the time that specific measures were introduced, the death rate had declined to 417 per 100,000 in 1949. With the introduction of BCG vaccination and antimicrobial drug treatment, by 1959 the death rate declined to 39 per 100,000.<p> By the early 1960s tuberculosis mortality was successfully controlled in Saskatchewan, although death rates remained 15 times higher among the Indians. Tuberculosis morbidity continued to be a problem into the 1980s. In 1984, the incidence of tuberculosis was 21 times greater among the Indians than the corresponding rate in the non-Indian population.<p> Various environmental and cultural factors contributed to the Indian population's experiences with tuberculosis. The most important factor was the absence of population immunity. In addition, concentration of the population on reserves, the occurrence of intercurrent epidemics, sudden and dramatic dietary change, and lifestyle factors such as housing, sanitation and personal hygiene all contributed to incredibly high tuberculosis mortality in this population. The effect of medical care on the epidemiology of tuberculosis in the Saskatchewan Indians was not even considered in the preliminary analysis of the epidemic, because throughout the first several decades of the epidemic, no organized health services existed for the Indians.<p> In Saskatchewan, before World War II, medical services to the Indians were characterized by occasional surveys, the employment of part-time physicians, and health education through the distribution of circulars to Indian agents on health-related issues. Organized anti-tuberculosis programs which were developed in the years following the Second World War, in a large part, account for the dramatic decrease in the tuberculosis death rate in the province through the decade of the 1950s.<p> In the late 1940s, and throughout the 1950s and 1960s, most active Indian tuberculosis cases diagnosed in Saskatchewan were hospitalized for treatment. At least 10% of the Indian population of Saskatchewan received Indian hospital or sanatorium treatment throughout the first decade that those services were available to them.<p> Interviews conducted with fourteen Indian individuals who had been hospitalized for tuberculosis treatment provided two dichotomous perspectives on tuberculosis. Several individuals feared tuberculosis because of their familiarity with it in their families and on their reserves, however, most said that they knew tuberculosis, but they did not fear it. In terms of their knowledge about tuberculosis from a biomedical perspective, most had some idea of its symptomology although its specific etiology was not known. Most of the people interviewed appeared to understand the infectious nature of tuberculosis, however, their concern for their families may have stemmed from observations that tuberculosis was "in" particular families, not necessarily because they thought they could "give" tuberculosis to them. In terms of a perspective on the treatment of tuberculosis, most of the individuals interviewed were aware that hospital treatment was necessary. Archival sources and government annual reports, indicated that many Indians took a very active role in attending to their health needs. None of the individuals who were interviewed refused to go to the sanatorium, except for one woman who ran away several times. Most, however, planned their escape time after time. This suggests that their stay in the sanatorium and hospital may not have been of their own volition.<p> The most common and recurring theme that emerged from the interviews about life in the sanatoria or Indian hospital revolved around the structured, regimented nature of the treatment. Several individuals remembered quite vividly seeing other patients confined in strait jackets and body casts and distinctly remembered how strict the staff was with children.<p> While they were hospitalized, all of the individuals who were interviewed knew several other people who were being treated at the same time who were also their contemporaries from their own or surrounding reserves. All of the individuals also made several lasting friendships with people that they met while in the sanatorium. In addition, all, except for one young boy, were visited frequently by their families and friends. This indicates that the Indian people interviewed were not "isolated" from their families and friends for the duration of their treatment. Hospitalization, for those interviewed, was not a traumatic event because they had an extensive social network which enabled them to cope with the experience. In addition, because of the poor living conditions on many Indian reserves, a trip to the sanatorium or Indian hospital was a relief for some. Indian children in the sanatorium and hospital were given new clothes, toys, and books, and in some cases an education; things they did not get at home. One woman chose to remain in the sanatorium after her treatment regimen ended so that she could complete her education, something she could not do back at home in the north. Only one individual suggested that the experience was instrumental in determining the direction his future took.<p> In demonstrating that this was an era in which disease played a major role in the lives of the Indians, the epidemiology of tuberculosis in this population illustrated the pervasive influence that tuberculosis had on demographic and biological aspects of the population. The history of health services illustrated the role of medical intervention in the ecology of tuberculosis in this population. As a probe for behaviourial adaptations to disease on the individual level, the interviews contributed a human dimension to the study. To complete the picture of the role of disease in the lives of the Indians, the examination of the final component in adaptation, behaviourial adaptation to disease at the cultural level, is recommended.

A prevalência de fatores de risco cardiovascular, com destaque para a hipertensão arterial tem mostrado tendência presente e ascendente em populações indígenas. O objetivo principal desse estudo foi comparar o perfil de fatores de risco cardiovascular, com destaque para hipertensão arterial, em indígenas Mura da área rural e urbana do município de Autazes, Amazonas. Casuística e Métodos: Estudo transversal, realizado no município de Autazes no estado do Amazonas com 455 indígenas da etnia Mura (234 indígenas da área rural e 221 da área urbana). Os participantes foram caracterizados em relação a variáveis sociodemográficas, hábitos e estilos de vida, condições de saúde, perfil antropométrico, perfil lipídico e glicemia de jejum. A pressão arterial foi avaliada pela medida casual, com aparelho automático validado. Hipertensão foi definida para valores 140 e/ou 90 mmHg ou diagnóstico prévio de hipertensão.Avaliou-se os fatores associados a hipertensão arterial, por meio da regressão de Poisson com variância robusta, sendo considerados estatisticamente significativos, valores de p0,05. Resultados: A maioria era do sexo feminino (57,8%), a média de idade foi de 42,2(16,7) anos, analfabetismo e ensino fundamental incompleto (58,0%), morando com companheiro (73,5%). A prevalência de hipertensão nos indígenas Mura foi de 26,6% (IC95% 22,5-30,7), menor entre os da área rural (21,8% vs 31,7%,p0,05). Os indígenas Mura da área rural foram diferentes (p0,05) dos indígenas da área urbana, respectivamente, em relação a: idade menos elevada [40,5(16,5) vs 43,7(16,8) anos)]; estado civil amasiado (58,2% vs 33,4%); renda familiar menorque três salários (43,6% vs 51,6%); mais trabalho temporário (61,5% vs 47,1%); venda mais elevada de produtos agropecuários e da pesca (53,4% vs 30,3%); pertencentes a classe econômica D e E (97,8% vs 74,2%). Em relação às características antropométricas, os indígenas da área rural foram diferentes (p0,05) dos da área urbana, respectivamente, para: IMC menos elevado [25,7(4,1) vs 27,6(5,2) kg/m²]; presença de obesidade (15,8% vs 35,3%); circunferência da cintura aumentada substancialmente (8,5% vs 42,1%); relação cintura quadril aumentada (81,2% vs 89,1%); percentual de gordura corporal muito alta (32% vs 48,8%); gordura visceral alto (17,1% vs 25,3%). Quanto aos hábitos e estilos de vida, os indígenas da área rural foram diferentes (p0,05) dos da área urbana em relação ao: menor índice de tabagismo com 11 anos ou mais (46,5% vs 62,0%); maior índice de: etilismo (57,3% vs 22,2%), sedentarismo (17,1% vs 11,3%)]. Quanto o modo de preparo dos alimentos, os indígenas da área rural se diferenciaram (p0,05) dos da área urbana, respectivamente, quanto à maior: utilização do método da cocção (81,2% vs 72,8%); adição de sal nas refeições prontas (58,1% vs 43,9%) e utilização de açúcar (100% vs 97,7%). Em relação à hipertensão arterial, os indígenas da área rural foram diferentes (p0,05) dos da área urbana, respectivamente, quanto à: menor prevalência de hipertensão referida (12,8% vs 28,1%); receberam menos orientações para tratamento não medicamentoso (18,2% vs 55,8%); deixaram de comparecer às consultas marcadas por falta de dinheiro (68,4% vs 25,0%); tinham dificuldade para realizar o tratamento medicamentoso por esquecimento (85,0% vs 14,3%). Quanto aos antecedentes familiares de doenças cardiovasculares, os indígenas da área rural referiram menos (p0,05): problemas de coração (28,6% vs 34,8%), acidente vascular encefálico (22,6% vs 34,8%), diabetes mellitus (26,0% vs 45,7%), dislipidemias (25,6% vs 43,9%) e de hipertensão arterial (57,7% vs 72,4%). Em relação aos antecedentes pessoais, os indígenas da área rural foram diferentes (p0,05) ao referirem ausência: de problemas de coração (63,7% vs 72,4%), de acidente vascular encefálico (99,1% vs 94,1%), de diabetes mellitus (62,0% vs 83,3%) e de dislipidemias (56,0% vs 60,3%). Os indígenas hipertensos foram estatisticamente diferentes dos indígenas não hipertensos, respectivamente, em relação a: idade mais elevada [53,6(16,6) vs 37,9(14,4) anos]; analfabetismo e ensino fundamental incompleto (71,0% vs53,3%); viver sem companheiro (60,3% vs 77,2%); renda familiar menor que três salários (57,1% vs 44,0%); tinham menos trabalho remunerado temporário (46,3% vs 57,5%); menos benefício de programa social (43,8% vs 66,2%); aposentados (43,0% vs 20,4%). Os indígenas hipertensos foram diferentes (p0,05) dos indígenas não hipertensos por apresentarem a maior elevação: do IMC [28,9(5,0) vs 25,8(4,3) kg/m²], de obesidade (40,5% vs 19,8%), da circunferência do pescoço aumentada (75,2% vs 54,8%); da circunferência da cintura aumentada substancialmente (28,1% vs 21,9%), da relação cintura quadril aumentada (95,0% vs 81,4%), índice de conicidade mais elevado [1,32(0,05) vs 1,25(0,07)], gordura visceral muito alto (55,4% vs 34,7 gordura corporal muito alto (22,3% vs 5,7%); músculo esquelético baixo (45,0% vs 25,1%). Apresentaram ainda: triglicérides alto (30,6% vs 16,8%); colesterol alto (16,5% vs 6,0%); diabetes mellitus (6,6% vs 1,8%). Quanto aos hábitos de vida, os indígenas hipertensos referiram menos (p0,05): tabagismo (12,4% vs 23,4%), utilização de pílula ou hormônio anticoncepcional (15,1% vs 26,8%, p0,05). Eram mais praticantes de atividades físicas regulares (50,4% vs 46,1%). Quanto à alimentação, os indígenas hipertensos foram diferentes (p0,05) quanto à menor aquisição de alimentos da caça e/ou pesca (48,8% vs 68,3%), menor utilização de óleo vegetal (96,7% vs 99,7%) e adição de sal nas refeições prontas (43,0% vs 54,2%), porém utilizava mais gordura animal ou banha para o preparodos alimentos (12,7% vs 5,1%). Os indígenas hipertensos foram diferentes (p0,05) dos indígenas não hipertensos por apresentarem respectivamente mais história pregressa: de problemas de coração (14,9% vs 3,6%), de ocorrência de acidente vascular encefálico (9,1% vs 1,2%), ter diabetes mellitus (12,4% vs 2,4%) e ter tido e/ou ainda possuir dislipidemias (29,2% vs 9,6%).O fator de risco não modificável associado à hipertensão foi a idade [RP ajustada = 1,04 (IC95% 1,03-1,05)]. Entre os fatores modificáveis associaram-se à hipertensão: o IMC [RP ajustada = 1,07 (IC95%1,05-1,10)], os triglicerídeos classificados como limítrofe [RP ajustada = 1,68 (IC95% 1,19-2,38)] e alto [RP ajustada = 1,47 ( IC95% 1,06-2,04)], antecedente pessoal de dislipidemia [RP ajustada = 1,50(IC95% 1,09-1,94)], preparo de alimentos com gordura animal [RP ajustada = 1,89(IC95% 1,30-2,74)] e com gordura vegetal animal [RP ajustada = 0,36(IC95% 0,26-0,51)]. Conclusão: A prevalência de hipertensão foi alta, ainda se observou sinais de mudanças de hábitos e estilos de vidas, semelhantes à população não indígena. / The prevalence of cardiovascular risk factors, highlighting the arterial hypertension, has shown current and ascendant trend in Indian samples. The main objective of this study was to compare the profile of cardiovascular risk factors, emphasizing the arterial hypertension, of Mura ethnicitys Indians from rural and urban zones in Autazes, Amazon. Casuistic and Methods: cross-sectional research conducted in Amazon state with 455 Indians from the Mura ethnicity (234 Indians from rural zone and 221 from urban zone). We characterized the sample regarding sociodemographic variables, habits and lifestyle, health status, anthropometric profile, fat levels, and fasting glucose.Blood pressure was assessed trough casual measure with a validated automatic device.Hypertension was defined when blood pressure was 140 and/or90 mmHg or face a previous medical diagnosis of it.Poisson Regression with robust variance was applied to assess the factors associated with arterial hypertension. P values 0,05 were considered statistically significant. Results: Most of sample was complained for women (57,8%), with mean age of 42,2(16,7) years, Illiteracy and incomplete basic education (58,0%) and living with a partner (73,5%). The prevalence of hypertension in the Mura Indians was of 26,6% (95% CI 22,5-30,7), lower among those from rural zone (21,8% vs 31,7%, p0,05). The Mura Indians from rural area were different (p0,05) of those from urban ones regarding to: early age [40,5(16,5) vs43,7(16,8) years)]; cohabitating marital status (58,2% vs 33,4%); family income lower than 3 minimum wages (43,6% vs 51,6%); extra temporary work (61,5% vs 47,1%); increased selling of agricultural and fishing products (53,4% vs 30,3%); and pertaining the economic classesD and E (97,8% vs 74,2%). Concerning the anthropometric features, the Indians from rural area were different (p0,05) of those from urban zones, respectively, for: lower IMC [25,7(4,1) vs 27,6(5,2) kg/m²]; presence of obesity (15,8% vs 35,3%); substantially increasedwaist circumference (8,5% vs 42,1%); increased waist-hip ratio (81,2% vs 89,1%); very high Fat body percentage (32,0% vs 48,8%); high visceral fat (17,1% vs 25,3%). About habits and lifestyle, Indians from the rural zone showed difference (p0,05) to the other group regarding: lower index of smoking- 11 years or more (46,5% vs 62,0%); higher index of alcoholism (57,3% vs 22,2%); and sedentary lifestyle (17,1% vs 11,3%)]. The use of cooking method (81,2% vs 72,8%); extra salt in ready meals (58,1% vs 43,9%) and sugar intake (100% vs 97,7%) were different between the groups. In relation to arterial hypertension, both groups had differed (p0,05) in respect of: lower prevalence of referred hypertension (12,8% vs 28,1%); poorly guided about non-pharmacological treatment (18,2% vs 55,8%); absence in medical consultation due to lack of money (68,4% vs 25,0%); and difficulty to attend the pharmacological therapy due to forgetting (85% vs 14,3%). About the family background on heart diseases, the Indians from rural zone reported less (p0,05): heart diseases(28,6% vs 34,8%), brain stroke (22,6% vs 34,8%), diabetes mellitus (26,0% vs 45,7%), dyslipidemias (25,6% vs 43,9%) andarterial hypertension (57,7% vs 72,4%). The personal antecedents of rural Indians were different (p0,05) in the absence of: heart diseases (63,7% vs 72,4%), brain stroke (99,1% vs 94,1%), diabetes mellitus (62,0% vs 83,3%) and dyslipidemias (56,0% vs 60,3%). Hypertensive Indians were statistically different from the healthy ones regarding to: advanced age [53,6(16,6) vs 37,9(14,4) years]; Illiteracy and incomplete basic education (71,0% vs 53,3%); single marital status (60,3% vs 77,2%); family income less than three minimum wages (57,1% vs 44,0%); less temporary paid labor (46,3% vs 57,5%); less social programs benefits (43,8% vs 66,2%); retired (43,0% vs 20,4%). The group(hypertensive) differed by presenting increased: BMI [28,9(5,0) vs 25,8(4,3) kg/m²], obesity (40,5% vs 19,8%), neck circumference (75,2% vs 54,8%); waist circumference (28,1% vs 21,9%), hip-waist ratio (95,0% vs 81,4%), conicity index [1,32(0,05) vs 1,25(0,07)], visceral fat (55,4% vs 34,7),body fat (22,3% vs 5,7%); and poor skeletal muscle (45,0% vs 25,1%). They also presented: high levels of triglycerides (30,6% vs 16,8%); high cholesterol levels (16,5% vs 6,0%); and diabetes mellitus (6,6% vs 1,8%). Concerning life habits, hypertensives Indians referred less: smoking (12,4% vs 23,4%) and use of contraceptive pill or hormones (15,1% vs 26,8%, p0,05). They practice more regular physical activities than the non-hypertensive individuals (50,4% vs 46,1%). Hypertensive Indians were different on nutrition, regarding to: lower acquisition of hunting and fishing foods (48,8% vs 68,3%), lower use of vegetal oil (96,7% vs 99,7%) and higher salt addition in ready meals (43,0% vs 54,2%). However, they use more animal fat or lard for foods preparation (12,7% vs 5,1%). These hypotensive Indians had also more previous antecedents of: heart diseases (14,9% vs 3,6%), brain stroke occurrence (9,1% vs 1,2%), diabetes mellitus (12,4% vs 2,4%) and presence or historic of dyslipidemias (29,2% vs 9,6%).The unchangeable risk factor associated to hypertension was age [PR adjusted = 1,04 (95% CI1,03-1,05)]. The following changeable risk factors associated to the outcome were: BMI [PR adjusted= 1,07 (95% CI1,05-1,10)], border [PR adjusted = 1,68 (95% CI1,19-2,38)] and high [PR adjusted = 1,47 (95% CI1,06-2,04)] levels of triglycerides, personal records of dyslipidemia [PR adjusted = 1,50(95% CI1,09-1,94)], food preparation with animal [PR adjusted = 1,89(95% CI1,30-2,74)] and animal-vegetal fats [PR ajusted = 0,36(95% CI0,26-0,51)]. Conclusion: Hypertension was highly prevalent and the signs of lifestyles and habits changes were similar to those found in non-Indian population.

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