IJCS | Volume 33, Nº3, May / June 2020

218 Moreira et al. Cardiovascular risk in hypertensive individuals Int J Cardiovasc Sci. 2020; 33(3):217-224 Original Article risk stratification to define the prognosis and clinical approach to hypertension in primary health care (PHC), including the adoption of the Framingham risk score (FRS). The FRS is an algorithm traditionally used as a strategy for preventing cardiovascular diseases in asymptomatic individuals. 3 To establish a 10-year CVD risk, the FRS considers the following factors: total cholesterol and HDL cholesterol levels, systolic blood pressure, diabetes mellitus, smoking habit and age. 3,5,6 Studies have shown that the score is a potential instrument to help health professionals in the development of more appropriate approaches to hypertensive patients. 5 In view of the high prevalence of AH and the impact of cardiovascular diseases, studies aiming at identify the cardiovascular risk (CVR) are needed to contribute to the implementation of effective therapeutic measures. 7 The objective of this study was to identify the CVR in hypertensive patients seen at primary health care centers, using the FRS, and to evaluate possible associations and correlations of CVRwith other sociodemographic, clinical and laboratory variables not included in this score. Methods This is a cross-sectional study conducted with PHC patients with AH in the municipality of Zona da Mata, located in Minas Gerais State, Brazil, in the period from July toAugust 2013. For sample calculation, a population of 293 patients who participated in educational activities performed in groups, at the primary health care center of the municipality once a month, with an expected frequency of 50% and an error of 5% was considered. A total of 166 patients were selected by random draw. Data were collected by individual, semi-structured interview, addressing sociodemographic variables and life habits. The International Physical Activity Questionnaire (IPAQ) 8 was applied to identify and quantify physical activity (PA), consisting of questions about the frequency and duration of physical activities at work (moderate and vigorous walking), while commuting, in domestic activities, and in leisure time. PA was measured in minutes per week by multiplying weekly frequency by each event’s duration of each. Anthropometric and biochemical assessments were also performed. Participants were classified as to leisure-time activities as follows: • sedentary (< 10 min/week, any PA); • not very active (≥ 10 min to < 150 min/week of walking, moderate PA and/or 10 min to < 60 min/week of vigorous PA and/or 10 min to < 150 min/week of any combination of walking, moderate and vigorous PA); • physically active (≥ 150 min/week of walking, moderate PA and/or ≥ 60min/week of vigorous PA and/or ≥ 150min/week of any combination of walking, moderate and vigorous PA); • very active (≥ 150 min/week of vigorous PA, or ≥ 60 min/week of vigorous PA plus 150 min/week of any combination of walking and moderate PA). For dichotomized analyses, participants classified as sedentary and not very active were considered sedentary, and participants classified as physically active and very active were considered active. Anthropometric assessment was made by weight, height and waist circumference (WC) measurements. Body weight was obtained using an electronic scale, with a capacity of 150 kg and accuracy of 50 grams; and the height was measured using a portable stadiometer, composed of a metallic platform and removable wooden measuring rod containing and a headboard, according to the techniques proposed by Jellife. 9 The BMI (body mass index) was calculated by the ratio between the weight and squared height, and classified according to theWHO criteria for adults, 10 and Lipschitz for elders. 11 WCmeasurementwas performedusing an inextensible tape and measured in centimeters, at the midpoint between the iliac crest and the external face of the last rib. The results obtained were classified according to CVR andmetabolic complications according to the cutoff points proposed by the WHO. Laboratory analyses included: fasting blood glucose, total cholesterol and fractions, triglycerides, serum creatinine, urea, uric acid, and urine albumin (24- hour urine test). Glomerular filtration rate (GFR) was calculated using the CKD-EPI formula. 12 Participants were explained about the procedure of 24-hour urine collection, in addition to receiving written instructions and containers for urine collection. On the scheduled day, participants attended the accredited laboratory to deliver the urine collected and to have blood samples collected. Participants were instructed to maintain their usual diets on the day before, and blood collection was carried out after a 12-hour overnight fast. Urine volumes less than 500 mL were not included. The collection and analysis of the biological material