Domingos Diogo

Hypertension Prevalence, Awareness, Treatment, and Control in Mozambique: Urban/Rural Gap During Epidemiological Transition

The prediction of cardiovascular risk profile trends in low-income countries and timely action to modulate their transitions are among the greatest global health challenges. In 2005 we evaluated a nationally representative sample of the Mozambican population (n=3323; 25 to 64 years old) following the Stepwise Approach to Chronic Disease Risk Factor Surveillance. Prevalence of hypertension (systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg and/or antihypertensive drug therapy), awareness (having been informed of the hypertensive status by a health professional in the previous year), treatment among the aware (use of antihypertensive medication in the previous fortnight), and control among those treated (blood pressure <140/90 mm Hg) were 33.1% (women: 31.2%; men: 35.7%), 14.8% (women: 18.4%; men: 10.6%), 51.9% (women: 61.1%; men: 33.3%), and 39.9% (women: 42.9%; men: 28.7%), respectively. Urban/rural comparisons are presented as age- and education-adjusted odds ratios (ORs) and 95% CIs. Among women, hypertension (OR: 2.0; 95% CI: 1.2 to 3.0) and awareness (OR: 4.3; 95% CI: 1.9 to 9.5) were more frequent in urban areas. No urban/rural differences were observed in men (hypertension: OR: 1.3, 95% CI: 0.9 to 2.0; awareness: OR: 1.5, 95% CI: 0.5 to 4.7). Treatment prevalence was not significantly different across urban/rural settings (women: OR: 1.4, 95% CI: 0.5 to 4.4; men: OR: 0.3, 95% CI: 0.1 to 1.4). Control was less frequent in urban women (OR: 0.2; 95% CI: 0.0 to 1.0) and more frequent in urban men (OR: 78.1; 95% CI: 2.2 to 2716.6). Our results illustrate the changing paradigms of “diseases of affluence” and the dynamic character of epidemiological transition. The urban/rural differences across sexes support a trend toward smaller differences, emphasizing the need for strategies to improve prevention, correct diagnosis, and access to effective treatment.

Influence of two doses of irbesartan on non-dipper circadian blood pressure rhythm in salt-sensitive black hypertensives under high salt diet.

&NA; The authors examined whether the blockage of angiotensin II receptors by irbesartan (IRB) can reverse the “non‐dipper” circadian rhythm of blood pressure (BP) to a “dipper” pattern in black salt‐sensitive hypertensive patients submitted to a high‐sodium loading. Twelve black salt‐sensitive hypertensive patients (seven men; age, 35–58 years) on a high‐sodium diet (300 mmol Na+ per day) were followed for 8 weeks. A placebo was given during the first 2 weeks, followed by 2 weeks on IRB 150 mg/d, 2 weeks on placebo, and 2 weeks on IRB 300 mg/d. On the last day of placebo, IRB 150 mg/d, and IRB 300 mg/d treatments, 24‐hour BP and urinary 24‐hour excretion of Na+ and potassium were measured. On placebo, ambulatory mean arterial pressure (MAP) was 112 mm Hg ± 2 (24 h), 112 mm Hg ± 2 (daytime), and 111 mm Hg ± 2 (nighttime), showing a clear circadian non‐dipper profile. Versus placebo, IRB 150 mg/d reduced MAP by 4.2 mm Hg ± 1.1 (24 h), 2.6 mm Hg ± 0.8 (daytime) and 6.0 mm Hg ± 1.3 (nighttime; P < 0.05 vs. placebo) and IRB 300 mg/d reduced MAP by 7.8 mm Hg ± 1.4 (24 h), 3.9 mm Hg ± 1.1 (daytime), and 11.8 mm Hg ± 2.1 mm Hg (all P < 0.02 vs. placebo); nighttime/daytime MAP decrease was 0.7 ± 0.8% on placebo, 3.5 ± 2.1% on IRB 150 mg/d, and 7.0 ± 1.2% on IRB 300 mg/d (P < 0.02 for trend). Compared with placebo, IRB significantly increased serum potassium and plasma renin activity and reduced fractional excretion of potassium and plasma aldosterone levels in a dose‐dependent manner. Body weight and urinary sodium excretion did not change throughout the study. It was concluded that the angiotensin receptor blocker IRB can reverse the BP non‐dipper profile in salt‐sensitive hypertensive patients on a high‐salt diet, restoring nocturnal BP decline by a predominantly dose‐dependent reduction of nighttime BP. Although the increment of potassium balance and reduction of aldosterone may account for this effect, it occurs independently of increased natriuresis. It is speculated that blunting of nighttime BP decrease in black salt‐sensitive hypertensive patients may be related to a deficient suppression of the renin‐angiotensin system during the night.

The Effect of Season and Temperature Variation on Hospital Admissions for Incident Stroke Events in Maputo, Mozambique

BACKGROUND Identifying locale-specific patterns regarding the variation in stroke incidence throughout the year and with atmospheric temperature may be useful to the organization of stroke care, especially in low-resource settings. GOAL We aimed to describe the variation in the incidence of stroke hospitalizations across seasons and with short-term temperature variation, in Maputo, Mozambique. METHODS Between August 1, 2005, and July 31, 2006, we identified 651 stroke events in Maputo dwellers, according to the World Health Organizations STEPwise approach. The day of symptom onset was defined as the index date. We computed crude and adjusted (humidity, precipitation and temperature) incidence rate ratios (IRRs) and 95% confidence intervals (CIs) with Poisson regression. RESULTS Stroke incidence did not vary significantly with season (dry versus wet: crude IRR = .98, 95% CI: .84-1.15), atmospheric temperature at the index date, or average atmospheric temperature in the preceding 2 weeks. The incidence rates of stroke were approximately 30% higher when in the previous 10 days there was a decline in the minimum temperature greater than or equal to 3 °C between any 2 consecutive days (variation in minimum temperature -5.1 to -3.0 versus -2.3 to -.4, adjusted IRR = 1.31, 95% CI: 1.09-1.57). No significant associations were observed according to the variation in maximum temperatures. CONCLUSIONS Sudden declines in the minimum temperatures were associated with a higher incidence of stroke hospitalizations in Maputo. This provides important information for prediction of periods of higher hospital affluence because of stroke and to understand the mechanisms underlying the triggering of a stroke event.

Determinants of early case‐fatality among stroke patients in Maputo, Mozambique and impact of in‐hospital complications

The burden of stroke is increasing in developing countries that struggle to manage it efficiently. We identified determinants of early case-fatality among stroke patients in Maputo, Mozambique, to assess the impact of in-hospital complications. Patients admitted to any hospital in Maputo with a new stroke event were prospectively registered (n = 651) according to the World Health Organizations STEPwise approach, in 2005–2006. We assessed the determinants of in-hospital and 28-day fatality, independently of age, gender and education, and computed population attributable fractions. In-hospital mortality was higher among patients with Glasgow score at admission ≤6 (more than fivefold) or needing cardiopulmonary resuscitation during hospitalization (approximately 2·5-fold). Pneumonia and deep vein thrombosis/other cardiovascular complications during hospitalization were responsible for 19·6% (95% confidence interval, 5·3 to 31·7) of ischaemic stroke and 15·9% (95% confidence interval, 5·8 to 24·9) of haemorrhagic stroke deaths until the 28th day. Ischaemic stroke patients with systolic blood pressure 160–200 mmHg had lower in-hospital mortality (relative risk = 0·32, 95% confidence interval, 0·13 to 0·78), and, for those with haemorrhagic events (haemorrhagic stroke), 28-day mortality was higher when systolic blood pressure was over 200 mmHg (hazard ratio = 3·42; 95% confidence interval, 1·02 to 11·51), compared with systolic blood pressure 121–140 mmHg. Regarding diastolic blood pressure, the risk was lowest at 121–150 mmHg for ischaemic stroke and at 61–90 mmHg for haemorrhagic stroke. Early case-fatality was mostly influenced by stroke severity and in-hospital complications. The allocation of resources to the latter may have a large impact on the reduction of the burden of stroke in this setting.

Low prevalence of hypertension with pharmacological treatments and associated factors

OBJECTIVE To assess the determinants of the lack of pharmacological treatment for hypertension. METHODS In 2005, 3,323 Mozambicans aged 25-64 years old were evaluated. Blood pressure, weight, height and smoking status were assessed following the Stepwise Approach to Chronic Disease Risk Factor Surveillance. Hypertensives (systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg and/or antihypertensive drug therapy) were evaluated for awareness of their condition, pharmacological and non-pharmacological management, as well as use of herbal or traditional remedies. Prevalence ratios (PR) were calculated, adjusted for sociodemographic characteristics, cardiovascular risk factors and non-pharmacological treatment. RESULTS Most of the hypertensive subjects (92.3%), and nearly half of those aware of their condition were not treated pharmacologically. Among the aware, the prevalence of untreated hypertension was higher in men {PR = 1.61; 95% confidence interval (95%CI 1.10;2.36)} and was lower in subjects under non-pharmacological treatment (PR = 0.58; 95%CI 0.42;0.79); there was no significant association with traditional treatments (PR = 0.75; 95%CI 0.44;1.26). CONCLUSIONS The lack of pharmacological treatment for hypertension was more frequent in men, and was not influenced by the presence of other cardiovascular risk factors; it could not be explained by the use of alternative treatments as herbal/traditional medicines or non-pharmacological management. It is important to understand the reasons behind the lack of management of diagnosed hypertension and to implement appropriate corrective actions to reduce the gap in the access to healthcare between developed and developing countries.OBJETIVO: Analizar los determinantes de la falta de tratamiento farmacologico de la hipertension. METODOS: Se evaluaron 3.323 mozambicano de 25 a 64 anos en 2005. La presion arterial, peso, altura y tabaquismo fueron evaluados segun el estudio Stepwise Approach to Chronic Risk Factor Surveillance. Los hipertensos (presion arterial sistolica ≥ 140 mmHg y/o presion arterial diastolica i‚³90 mmHg y/o terapia anti-hipertensiva) fueron evaluados para verificar si eran conscientes de su hipertension, si recibian tratamiento farmacologico o no farmacologico, y si usaban hierbas o remedios tradicionales. Se calcularon los cocientes de prevalencia (PR) para hipertension no tratada, ajustadas para caracteristicas sociodemograficas, factores de riesgo cardiovascular y tratamiento no farmacologico. RESULTADOS: La mayoria de los hipertensos (92,3%) y casi la mitad de los conscientes de su hipertension no eran tratadas con farmacos. Entre los que sabian ser hipertensos, la hipertension sin tratamiento era mas frecuente en hombres (PR =1,61; IC95% 0,56;1,43) y no podia ser explicada por el uso de tratamiento no farmacologico (PR= 0,58; IC95% 0,42;0,79); no habia asociacion significativa con los tratamientos tradicionales (PR= 0,75; IC95% 0,44;1,26). CONCLUSIONES: La falta de tratamiento farmacologico de la hipertension, mas frecuente en hombres, no se explica por otros factores de riesgo cardiovascular, ni por el uso de tratamientos tradicionales o tratamiento no farmacologico. Es importante entender las razones de la falta de tratamiento de la hipertension diagnosticada e implementar medidas correctivas apropiadas, para reducir las diferencias en el acceso a cuidados de salud entre las poblaciones de los paises desarrollados y en vias de desarrollo.

On the Causal Paths Underlying the Relation between Atmospheric Temperature and Acute Stroke

3. Turin TC, Kita Y, Murakami Y, et al. Higher stroke incidence in the spring season regardless of conventional risk factors: Takashima Stroke Registry, Japan: 19882001. Stroke 2008;39:745-752. 4. Hong YC, Rha JH, Lee JT, et al. Ischemic stroke associated with decrease in temperature. Epidemiology 2003;14: 473-478. 5. Dawson J, Weir C, Wright F, et al. Associations between meteorological variables and acute stroke hospital admission in the west of Scotland. Acta Neurol Scand 2008; 117:85-89. 6. Li X, Zhang JH, Qin X. Intracerebral hemorrhage and meteorological factors in Chongqing, in the southwest of China. Acta Neurochir Suppl 2011;111:321-325. 7. Rumana N, Kita Y, Turin TC, et al. Seasonal pattern of incidence and case fatality of acute myocardial infarction in a Japanese population (From the Takashima AMI Registry, 1988-2003). Am J Cardiol 2008;102:1307-1311. 8. Turin TC, Kita Y, Rumana N, et al. Increased risk of acute myocardial infarction during colder periods is independent of the conventional cardiovascular risk factors. Takashima AMI Registry, Japan. CVD Prev Control 2011;6:109-111. 9. Barnett AG, de Looper M, Farser JF. The seasonality in heart failure deaths and total cardiovascular deaths. Aust N Z J Public Health 2008;32:408-413. 10. Tofler GH, Muller JE. Triggering of acute cardiovascular disease and potential preventive strategies. Circulation 2006;114:1863-1872. 11. McArthur K, Dawson J, Walters M. What is it with the weather and stroke? Exp Rev Neurother 2010;10: 243-249.

Baja prevalencia de hipertension con tratamiento farmacologico y factores asociados

OBJECTIVE To assess the determinants of the lack of pharmacological treatment for hypertension. METHODS In 2005, 3,323 Mozambicans aged 25-64 years old were evaluated. Blood pressure, weight, height and smoking status were assessed following the Stepwise Approach to Chronic Disease Risk Factor Surveillance. Hypertensives (systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg and/or antihypertensive drug therapy) were evaluated for awareness of their condition, pharmacological and non-pharmacological management, as well as use of herbal or traditional remedies. Prevalence ratios (PR) were calculated, adjusted for sociodemographic characteristics, cardiovascular risk factors and non-pharmacological treatment. RESULTS Most of the hypertensive subjects (92.3%), and nearly half of those aware of their condition were not treated pharmacologically. Among the aware, the prevalence of untreated hypertension was higher in men {PR = 1.61; 95% confidence interval (95%CI 1.10;2.36)} and was lower in subjects under non-pharmacological treatment (PR = 0.58; 95%CI 0.42;0.79); there was no significant association with traditional treatments (PR = 0.75; 95%CI 0.44;1.26). CONCLUSIONS The lack of pharmacological treatment for hypertension was more frequent in men, and was not influenced by the presence of other cardiovascular risk factors; it could not be explained by the use of alternative treatments as herbal/traditional medicines or non-pharmacological management. It is important to understand the reasons behind the lack of management of diagnosed hypertension and to implement appropriate corrective actions to reduce the gap in the access to healthcare between developed and developing countries.OBJETIVO: Analizar los determinantes de la falta de tratamiento farmacologico de la hipertension. METODOS: Se evaluaron 3.323 mozambicano de 25 a 64 anos en 2005. La presion arterial, peso, altura y tabaquismo fueron evaluados segun el estudio Stepwise Approach to Chronic Risk Factor Surveillance. Los hipertensos (presion arterial sistolica ≥ 140 mmHg y/o presion arterial diastolica i‚³90 mmHg y/o terapia anti-hipertensiva) fueron evaluados para verificar si eran conscientes de su hipertension, si recibian tratamiento farmacologico o no farmacologico, y si usaban hierbas o remedios tradicionales. Se calcularon los cocientes de prevalencia (PR) para hipertension no tratada, ajustadas para caracteristicas sociodemograficas, factores de riesgo cardiovascular y tratamiento no farmacologico. RESULTADOS: La mayoria de los hipertensos (92,3%) y casi la mitad de los conscientes de su hipertension no eran tratadas con farmacos. Entre los que sabian ser hipertensos, la hipertension sin tratamiento era mas frecuente en hombres (PR =1,61; IC95% 0,56;1,43) y no podia ser explicada por el uso de tratamiento no farmacologico (PR= 0,58; IC95% 0,42;0,79); no habia asociacion significativa con los tratamientos tradicionales (PR= 0,75; IC95% 0,44;1,26). CONCLUSIONES: La falta de tratamiento farmacologico de la hipertension, mas frecuente en hombres, no se explica por otros factores de riesgo cardiovascular, ni por el uso de tratamientos tradicionales o tratamiento no farmacologico. Es importante entender las razones de la falta de tratamiento de la hipertension diagnosticada e implementar medidas correctivas apropiadas, para reducir las diferencias en el acceso a cuidados de salud entre las poblaciones de los paises desarrollados y en vias de desarrollo.

Baixa prevalencia de hipertensao com tratamento farmacologico e fatores associados

OBJECTIVE To assess the determinants of the lack of pharmacological treatment for hypertension. METHODS In 2005, 3,323 Mozambicans aged 25-64 years old were evaluated. Blood pressure, weight, height and smoking status were assessed following the Stepwise Approach to Chronic Disease Risk Factor Surveillance. Hypertensives (systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg and/or antihypertensive drug therapy) were evaluated for awareness of their condition, pharmacological and non-pharmacological management, as well as use of herbal or traditional remedies. Prevalence ratios (PR) were calculated, adjusted for sociodemographic characteristics, cardiovascular risk factors and non-pharmacological treatment. RESULTS Most of the hypertensive subjects (92.3%), and nearly half of those aware of their condition were not treated pharmacologically. Among the aware, the prevalence of untreated hypertension was higher in men {PR = 1.61; 95% confidence interval (95%CI 1.10;2.36)} and was lower in subjects under non-pharmacological treatment (PR = 0.58; 95%CI 0.42;0.79); there was no significant association with traditional treatments (PR = 0.75; 95%CI 0.44;1.26). CONCLUSIONS The lack of pharmacological treatment for hypertension was more frequent in men, and was not influenced by the presence of other cardiovascular risk factors; it could not be explained by the use of alternative treatments as herbal/traditional medicines or non-pharmacological management. It is important to understand the reasons behind the lack of management of diagnosed hypertension and to implement appropriate corrective actions to reduce the gap in the access to healthcare between developed and developing countries.OBJETIVO: Analizar los determinantes de la falta de tratamiento farmacologico de la hipertension. METODOS: Se evaluaron 3.323 mozambicano de 25 a 64 anos en 2005. La presion arterial, peso, altura y tabaquismo fueron evaluados segun el estudio Stepwise Approach to Chronic Risk Factor Surveillance. Los hipertensos (presion arterial sistolica ≥ 140 mmHg y/o presion arterial diastolica i‚³90 mmHg y/o terapia anti-hipertensiva) fueron evaluados para verificar si eran conscientes de su hipertension, si recibian tratamiento farmacologico o no farmacologico, y si usaban hierbas o remedios tradicionales. Se calcularon los cocientes de prevalencia (PR) para hipertension no tratada, ajustadas para caracteristicas sociodemograficas, factores de riesgo cardiovascular y tratamiento no farmacologico. RESULTADOS: La mayoria de los hipertensos (92,3%) y casi la mitad de los conscientes de su hipertension no eran tratadas con farmacos. Entre los que sabian ser hipertensos, la hipertension sin tratamiento era mas frecuente en hombres (PR =1,61; IC95% 0,56;1,43) y no podia ser explicada por el uso de tratamiento no farmacologico (PR= 0,58; IC95% 0,42;0,79); no habia asociacion significativa con los tratamientos tradicionales (PR= 0,75; IC95% 0,44;1,26). CONCLUSIONES: La falta de tratamiento farmacologico de la hipertension, mas frecuente en hombres, no se explica por otros factores de riesgo cardiovascular, ni por el uso de tratamientos tradicionales o tratamiento no farmacologico. Es importante entender las razones de la falta de tratamiento de la hipertension diagnosticada e implementar medidas correctivas apropiadas, para reducir las diferencias en el acceso a cuidados de salud entre las poblaciones de los paises desarrollados y en vias de desarrollo.

Comparison between clinical and echocardiographic patterns of dilated cardiomiophaty secondary to hypertension and primary dilated cardiomiophaty

Abstract P-144 Comparative values (means and std) of the clinical and echocardiographic parameters of primary DCM and DCM secondary to HTA. MBP EF % LVSD mm SW mm FW mm LVM gr LVMI g/m2 DCM HTA (age 61) 117 ± 11 27 ± 8 55 ± 4 10 ± 2 9 ± 2 303 ± 71 78 ± 20 PDCM (age 53) 92 ± 12 22 ± 7 60 ± 7 8 ± 1 8 ± 2 269 ± 68 72 ± 23 p 0.02 0.013 0.02 0.001 0.001 0.024 0.1 Key Words: Dilated Cardiomiopathy, Hypertension,