Hypertension in a resource‐limited setting: Poor Outcomes on Short‐term Follow‐up in an Urban Hospital in Maputo, Mozambique

Abstract

Mozambique has low levels of detection, treatment, and control of hypertension. However, data on target organ damage and clinical outcomes are lacking. The authors aimed at characterizing the clinical profile, pattern of target organ damage, and short‐term outcomes of patients referred to a first referral urban hospital in a low‐income setting in Africa. We conducted a prospective descriptive cohort study from February 2016 to May 2017 in Maputo, Mozambique. Adult patients with systolic and diastolic blood pressure ≥180 mm Hg and/or ≥110 mm Hg, respectively, or any systolic blood pressure above 140 mm Hg and/or diastolic blood pressure above 90 mm Hg in the presence of target organ damage (with or without antihypertensive treatment) were submitted to detailed physical examination, funduscopy, laboratory profile, electrocardiography, and echocardiography. Six months after the occurrence of complications (stroke, heart failure, and renal failure), hospital admission and death were assessed. Overall, 116 hypertensive patients were recruited (mean age 57.5 ± 12.8 years old; 111[95.7%] black; 81[70%] female) of which 79 had severe hypertension. The baseline mean values recorded for systolic and diastolic blood pressure were 192.3 ± 23.6 and 104.2 ± 15.2 mm Hg, respectively. Most patients (93; 80.2%) were on antihypertensive treatment. Patients’ risk profile revealed dyslipidemia, obesity, and diabetes in 59(54.1%), 48(42.5%), and 23(19.8%), respectively. Target organ damage was found in 111 patients. The commonest being left atrial enlargement 91(84.5%), left ventricular hypertrophy 57(50.4%), hypertensive retinopathy 30(26.3%), and chronic kidney disease 27(23.3%). Major events during 6‐month follow‐up were hospitalizations in 10.3% and death in 8.6% of the patients. Worsening of target organ damage occurred in 10 patients: four stroke, two heart failure, and four renal damage. Patients with severe hypertension and target organ damage were young with high‐risk profile, low hypertension control, and high occurrence of complications during short‐term follow‐up. Efforts to improve high blood pressure control are needed to reduce premature mortality in this highly endemic poor setting.

Management of Hypertension in the Asia-Pacific Region: A Structured Review

“…The demographic and clinical characteristics of Asia-Pacific patients with hypertension do differ from those in the West, with the former having generally smaller BMI, higher rates of smoking, lower rates of alcohol consumption, higher incidence of previous stroke and a lower incidence of pre-existing CVD [ 160 ]. Data suggest that patients with hypertension in resource-limited settings are more likely to have end-organ damage compared with those in resource-rich settings [ 161 ], but there are limited data on this from Asia-Pacific. In addition, there are likely genetic variants related to hypertension development and treatment response that differ between patients in Asia-Pacific and Western populations, but more research is needed to define the clinical implications of such differences.…”

Empowering Frontline Primary Healthcare Workers in a Global Health Partnership Training of Trainers Intervention to Strengthen the Prevention and Control of Cardiovascular Disease in Mozambique

“…Three local specialists (cardiologist, internist and epidemiologist) were invited as advisors for a priority setting exercise. HTN – the most important risk factor for heart failure [ 17 ] and stroke [ 18 ] – and commonly associated DM [ 19 ] were considered the major priorities for our training model, with their complications included so that frontline workers are able to identify and refer patients in need of higher levels of care. INS’ assessment of the preparedness of MGH for HTN and DM care provision, previously done using an adaptation of the WHO Service Availability and Readiness Assessment survey [ 20 ], had revealed the lack of clinical guidelines for management of HTN [ 12 ] and DM as a critical gap.…”