IJCS | Volume 33, Nº3, May / June 2020

222 Moreira et al. Cardiovascular risk in hypertensive individuals Int J Cardiovasc Sci. 2020; 33(3):217-224 Original Article CVR showed a positive correlation with serum values of total cholesterol. High levels of cholesterol combined with hypertension are associated with an increased risk for coronary disease attributable to CVR fctors, 26 so that educational interventions may be fundamental to reduce cardiovascular morbidity and mortality. 27 Another important finding of this study was the association between increased use of drugs and increased CVR. A study conductedwith patients in northernMinas Gerais founddifferent results, showing aweak correlation between the number of anti-hypertensive drugs and the number of CVR factors in hypertensive patients. 5 In the present study, most hypertensive patients used two or more antihypertensive drugs. This may be explained by an inappropriate use of hypotensive medications, not adjusted to the presence of aggravating factors of cardiovascular risk, and a lack of standardization in the monitoring and management of AH in the PHC. 5 A study by Egan and colleagues 28 showed that the use of only 1 or 2 antihypertensive, advanced age and a high FRS are independent variables associated with the lack of blood pressure control in hypertensive patients, since individuals with high CVR used other medications, such as aspirin and lipid-lowering drugs. These authors also emphasize the importance of stratifying hypertensive patients using the FRS; once the CVR was identified, patients would benefit from the correct use of medicines, adjusted to their comorbidities, thus contributing to reducing cardiovascular morbidity and mortality, and avoiding the use of unnecessary medications in low- risk patients. Thus, the control of hypertensive patients should not be based solely on blood pressure values, but consist of a comprehensive approach, considering the associated risk factors. 28 Finally, the increasedGFRwas associatedwith reduced cardiovascular risk. According to Go et al., 29 reduced GFR is associatedwith the occurrence of cardiovascular events, regardless of the concomitant presence of other classic cardiovascular risk factors. Thus, although the decreased GFR related to age has been considered part of the normal aging process, it represents an independent risk factor for developing cardiovascular disease in elders. 30, 31 Patients with a GFR between 30 and 45 ml/min/ 1.73 m², when compared to those with a GFR above 60 ml/min/1.73 m², have 110% increased risk of cardiovascular mortality. Therefore, there is an inversely proportional relationship between GFR and the risk of cardiovascular morbidity, especially cardiovascular mortality. 12,32 In this sense, actions by interprofessional team at the PHC, must take advantage of the potentialities of the FRS in the classification of CVR, to develop guidelines directed to identify risks, encourage self-care and the shared the responsibility of AH management. 5 In addition, community health workers should be trained for the identification and referral of individuals with CVR factors, contributing to the management of hypertension and its complications. These workers can deal with a more systemized monitoring system and have direct contact with the users of the PHC services. 33 Also, actions of the interprofessional team should be directed to changes in life habits, including the use of technologies in health promotion and prevention of diseases related to AH in hypertensive patients. 34 This study highlights the important role of regular educational activities aimed at promoting healthier life habits and reducing CVR factors. Nevertheless, although PHC is a potential scenario for managing AH by means of the FRS, studies have revealed that most of hypertensive patients habe not been attended by health teams as advocated by guidelines for the management of chronic diseases, 5,24,35 highlighting the findings of this study to strengthen the appropriate management of these individuals. The main limitation of this study is related to the study type. Investigations of observational nature do not allow assessing the relationship between cause and effect, despite the association between the studied variables. Another limitation relates to the fact that the study has been performed with a specific sample of hypertensive patients, attending the PHC center of one municipality. Expanding the study to other regions and cities could be useful to analyze the reproducibility of the results. Conclusion This survey on CVR factors in hypertensive patients seen in a PHC center determined the health profile of this population, highlighting the need for specific interventions by the interprofessional team. The CVRwas associated with male sex and had a positive correlation with the number of medications used and elevated serumvalues of total cholesterol. In contrast, the risk was negatively correlated with estimated GFR. Most risk factors identified in this population consist of modifiable factors; however, when ignored, may result in health problems with high social and economic impact. In this sense, actions aimed at health education should be