Why is Paraguay a country with high rates of hypertension? Historical, environmental, and sociocultural determinants of hypertension

Abstract

Introduction: High blood pressure is one of the leading global public health problems and the most significant modifiable risk factor for cardiovascular disease and premature mortality. In Latin America, between 30% and 40% of adults have high blood pressure. In Paraguay, national risk factor surveys indicate that approximately 38.5% of the adult population suffers from this condition, placing the country among those with the highest prevalence in the region. However, the population-level determinants of this high prevalence have been scarcely analyzed from an integrative perspective.

Objective: To describe the available evidence on the historical, nutritional, sociocultural, and structural determinants associated with the high prevalence of hypertension in Paraguay.

Methods: A narrative review of the literature was conducted using international biomedical databases (PubMed/MEDLINE, Scopus, SciELO, and Google Scholar) and institutional documents from the Ministry of Public Health and international organizations. We included epidemiological studies, research on nutritional and social factors, and reports related to population-level determinants of hypertension.

Results: The evidence suggests that the high prevalence of hypertension in Paraguay reflects the interaction of multiple determinants. These include demographic transition and progressive urbanization, changes in the food environment associated with the nutritional transition and increased consumption of ultra-processed foods, growing physical inactivity, sociocultural factors related to dietary habits, and limitations in treatment adherence. These elements overlap with a biological susceptibility shared with other populations.

Conclusion: Hypertension in Paraguay should be understood as a multidimensional phenomenon resulting from the interaction between historical, nutritional, and sociocultural transformations that have modified the population’s cardiovascular environment. Understanding these determinants can contribute to the design of cardiovascular prevention strategies tailored to the national context.