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Cardiovascular risk in Mozambique: who should be treated for hypertension?

Damasceno, Albertinoa,b; Padrão, Patríciac,d; Silva-Matos, Carlae; Prista, Antóniof; Azevedo, Anab,c; Lunet, Nunob,c

doi: 10.1097/HJH.0b013e3283656a0a

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.

aFaculty 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

Correspondence to Nuno Lunet, Departamento de Epidemiologia Clínica, Medicina Preditiva e Saúde Pública, Faculdade de Medicina da Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal. Tel: +351 225513652; fax: +351 225513653; e-mail:

Abbreviations: BP, blood pressure; FBG, fasting blood glucose; ISH, International Society of Hypertension; STEPS, STEPwise Approach to Chronic Disease Risk Factor Surveillance; USD, United States Dollar

Received 14 March, 2013

Revised 24 July, 2013

Accepted 26 July, 2013

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins