Association between Systolic Blood Pressure

and Congestive Heart Failure

in Hypertensive Patients

Mrs. Sutheera Intajarurnsan

Doctor of Public Health Student

Faculty of Public Health, Khon Kaen University1

Outlines

Background Objectives Materials and Methods Results Discussions Conclusions

2

Background

As many as 1 billion people worldwide suffer from hypertension which estimated to cause 4.5% of current global disease burden

Of all the potential complications of hypertension, congestive heart failure (CHF) was the most consistently found, it is called

“Silent disease”

http://isp.swanih.org

http://www medical device network.com

3

Background (cont.)

Systolic blood pressure (SBP) is a major predictor of cardiovascular disease, one of complications in hypertensive (HT) patients

Gaps of knowledge:There are some controversial findings

regarding the association between SBP and risk of CHF.

http:// www. siamhealth.net

4

Objectives

To investigate the association between SBP and CHF among hypertensive patients in Thailand

5

Materials and Methods

Study designCross-sectional study

Based on the survey of the An Assessment on Quality of Care among Patients Diagnosed with Type 2 Diabetes (DM) and Hypertension (HT) Visiting Hospitals of Ministry of Public Health and Bangkok Metropolitan Administration in Thailand, from 2010 to 2012

6

Materials and Methods (cont.2)

Study outcomeAssociation between SBP and CHF

Independent variableSBP (polytomous categorical variables)

Dependent variableCHF (dichotomous categorical variables)

Covariate variablesGender, Age, Occupation, BMI, Smoking, Lipid profiles,

and ECG results

7

Materials and Methods (cont. 3)

Statistical analysisDescriptive analysisBivariate analysisMultivariate analysis (Multiple logistic regression)

All analyses were performed using Stata version 12.0 (Stata Corp, College Station, TX).

A p-value of less than 0.05 was considered statistical significant.

8

Results

9

Total sample of DMHT patients (n = 174,578)

Sample of HT (only) patients (n = 95,035)

CHF assessment (n= 38,480)

Exclude 24,266 of DMand 55,277 of DMHT

56,236 Missing and 319 not report in medical records

Results ; Characteristics

Gender

BMI

n= 38,429

Results ; Characteristics (cont. 2)

Smoking History

(*Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC); 7 th report, 2009.)n= 38,345

11

Results ; Factors associated with CHF complication in hypertensive patients

Fig. 2. Factors affecting CHF complication in hypertensive patients , presented as odds ratio adjusted for gender, age, occupation, BMI, SBP, DBP and smoking history, using multiple logistic regression

12

(≥ 160 mmHg)

(≥ 23 kg/m2 )

(≥100 mmHg)

DiscussionsThis findings There were no significant associations between

SBP and CHF complication among hypertensive patients (p = 0.223, 95%CI across 1.0)

However, hypertensive patients who had high systolic blood pressure levels, were likely to obtained occurring of CHF complication.

13

Discussions (cont. 2)

Previous findings The Framingham Heart Study showed hypertension

(SBP>140 mmHg) was associated with a two-fold increased risk of HF in men when compared with normal (SBP<140 mmHg)

Answer the gap of knowledge; These results likely presented the positive association but

not significant difference, which is not consistent with other studies.

14

Discussions (cont. 3)

StrengthNationally representative sampleReal situationsSaving for time and budget

LimitationInsufficient data and missing values in medical records

(handle by using best case and worst case method compared with based case)

Information bias from data recording by medical staffs

15

Conclusions

Systolic blood pressure was not significantly associated with congestive heart failure in hypertensive patients.

16

Recommendations

Interesting point that cloud be created for further study What is the cut off point for SBP level which predict the high risk

of CHF? (especially in Asian) Should required lager sample size Design the study by using an RCT

Benefits Studies regarding risk and protective factors lead to prevention of

morbidity and mortality among HT patients.

Therefore, further understanding of those factors that activate patients to CHF is essential to guide strategies for prevention.

17

Acknowledgements Collaborative partnerships of the Thailand National

Health Security Office (NHSO) and the Thailand Medical Research Network (MedResNet).

Prof. Dr. Bandit Thinkamrop Dr. Cameron Hurst

Miss Wilaiphorn Thinkamrop My seniors; especially Dr.PH batch 4

All my classmates; Dr.PH batch 5

18

Thank Youfor

Your Attention