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Cardiovascular risk in Mozambique: who should be treated for hypertension?
Albertino Damasceno1, Patrícia Padrão, Carla Silva-Matos
1aFaculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique bDepartment of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School cInstitute of Public Health, of the University of Porto (ISPUP) dFaculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal eDepartment of Non-Communicable Diseases, Mozambique Ministry of Health fFaculty of Physical Education and Sports Sciences, Universidade Pedagógica, Maputo, Mozambique.
Insights
Nearly 40% of Mozambicans aged 40-64 have high blood pressure, but only half meet WHO guidelines for hypertension treatment. Considering total cardiovascular risk improves resource allocation for hypertension control.
Area of Science:
- Cardiovascular epidemiology
- Public health interventions
- Hypertension management
Background:
- Hypertension is a major cardiovascular risk factor globally.
- Effective hypertension management is crucial for preventing cardiovascular events.
- Estimating treatment eligibility is key for resource allocation in public health.
Purpose of the Study:
- To determine the proportion of adult Mozambicans eligible for hypertension pharmacotherapy.
- To compare eligibility based on single risk factor versus total cardiovascular risk.
- To inform hypertension control strategies in resource-limited settings.
Main Methods:
- A representative sample of 1116 Mozambicans aged 40-64 years was surveyed using the WHO STEPwise Approach.
- Blood pressure, fasting blood glucose, and lifestyle factors were measured.
- 10-year cardiovascular risk was calculated using WHO/International Society of Hypertension charts.
Main Results:
- Nearly 40% of untreated individuals aged 40-64 had systolic/diastolic blood pressure (SBP/DBP) ≥140/90 mmHg.
- Less than 4% had a 10-year cardiovascular risk of ≥20%.
- 19.8% were eligible for pharmacotherapy based on WHO guidelines, all with SBP/DBP ≥160/100 mmHg.
Conclusions:
- Only about half of untreated hypertensive Mozambicans (SBP/DBP ≥140/90 mmHg) met WHO criteria for pharmacotherapy.
- Integrating total cardiovascular risk assessment enhances the efficiency of hypertension treatment strategies.
- This approach optimizes scarce healthcare resources in developing countries.
Aim:
To estimate the proportion of Mozambicans eligible for pharmacological treatment for hypertension, according to single risk factor and total cardiovascular risk approaches.
Methods:
A representative sample of Mozambicans aged 40-64 years (n=1116) was evaluated according to the WHO STEPwise Approach to Chronic Disease Risk Factor Surveillance (STEPS). We measured blood pressure (BP) and 12-h fasting blood glucose levels and collected data on sociodemographic characteristics, smoking, and use of antidiabetic and antihypertensive drugs. We estimated the 10-year risk of a fatal or nonfatal major cardiovascular event (WHO/International Society of Hypertension risk prediction charts), and computed the proportion of untreated participants eligible for pharmacological treatment for hypertension, according to BP values alone and accounting also for the total cardiovascular risk (WHO guidelines for assessment and management of cardiovascular diseases).
Results:
Among the Mozambicans aged 40-64 years and not taking antihypertensive drugs, less than 4% were classified as having cardiovascular risk at least 20% whereas the prevalence of SBP/DBP at least 140/90 mmHg was nearly 40%. A total of 19.8% of 40-64-year-olds would be eligible for pharmacological treatment of hypertension according to the WHO guidelines, all of whom had SBP/DBP at least 160/100 mmHg.
Conclusion:
Among the Mozambicans aged 40-64 years not taking antihypertensive drugs and having SBP/DBP at least 140/90 mmHg, only half were eligible for pharmacological treatment according to the WHO guidelines. Taking the latter into account, when defining strategies to control hypertension at a population level, may allow a more efficient use of the scarce resources available in developing settings.
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