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 University
Outlines • Background • Objectives • Materials and Methods • Results • Discussions • Conclusions
Background http://isp.swanih.org • As many as 1 billion people worldwide suffer from hypertension whichestimated 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://www medical device network.com
Background(cont.) http:// www. siamhealth.net • 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.
Objectives • To investigate the association between SBP and CHF among hypertensive patients in Thailand
Materials and Methods • Study design • Cross-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
Materials and Methods (cont.2) • Study outcome • Association between SBP and CHF • Independent variable • SBP(polytomous categorical variables) • Dependent variable • CHF (dichotomous categorical variables) • Covariate variables • Gender, Age, Occupation, BMI, Smoking, Lipid profiles, and ECG results
Materials and Methods (cont. 3) • Statistical analysis • Descriptive analysis • Bivariate analysis • Multivariate 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.
Results Population of DMHT patients registered Hospitals of Ministry of Public Health Since 2010-2012 (N = 6,277,543) Total sample of DMHT patients (n = 174,578) Exclude 24,266 of DM and 55,277 of DMHT Sample of HT (only) patients (n = 95,035) 56,236 Missing and 319 not report in medical records CHF assessment (n= 38,480)
Results ; Characteristics Gender n= 38,429 BMI
Results ; Characteristics (cont. 2) (*Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC); 7th report, 2009.) n= 38,345 Smoking History
Results; Factors associated with CHF complication in hypertensive patients (≥100 mmHg) (≥ 160 mmHg) (≥ 23 kg/m2 ) 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
Discussions This 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.
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.
Discussions (cont. 3) • Strength • Nationally representative sample • Real situations • Saving for time and budget • Limitation • Insufficient data and missing values in medical records (handle by using best case and worst case method compared with based case) • Information biasfrom data recording by medical staffs
Conclusions Systolic blood pressure was not significantly associated with congestive heart failure in hypertensive patients.
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.
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
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