Association between Systolic Blood Pressure

and Congestive Heart Failure Complication

among Hypertensive

and Diabetic 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 Recommendations

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Background

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

In addition, hypertension affects up to 60% of people with diabetes and substantially increases the risk of cardiovascular events, especially congestive heart failure (CHF), which is the potential complication.

They are leading causes of premature death and disability.

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Background (cont.)

Systolic blood pressure (SBP) is a major predictor of cardiovascular disease.

As increasing age, systolic blood pressure gradually rises while diastolic blood pressure starts to decline.

Gaps of knowledge:There are some controversial findings

regarding the association between SBP and risk of CHF.

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Objectives

Primary objective; to determine the association between SBP and CHF complication.

Secondary objective; to compare levels of those associations among hypertensive (HT) and diabetic hypertensive (DMHT) patients.

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Materials and Methods

Study designCross-sectional study

Based on the survey of 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

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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, Smoking, Body Mass Index (BMI) and

Fasting plasma glucose (FPG)

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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.

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Results

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

Sample of HT (only) and DMHT patients (n = 150,312)

Study participants (n = 150,312) ; 95,035 for HT (only)

55,277 for DMHT

Exclude 24,266 of DM (only)

Fig. 1. The inclusion flow chart

Results ; Characteristics

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Results ; Characteristics (cont. 2)

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Results ; Factors associated with CHF complication among hypertensive patients ; HT (only)

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

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Results ; Factors associated with CHF complication among diabetic hypertensive patients ; DMHT

Fig. 3. Factors affecting CHF complication in diabetic hypertensive patients , presented as odds ratio adjusted for gender, age, occupation, BMI, SBP, DBP and smoking history, using multiple logistic regression

DiscussionsAmong HT patients There were no significant associations between

SBP and CHF complication among hypertensive patients (OR = 1.08; 95%CI: 0.75-1.55; p= 0.673)

This results were not consistent with previous studies.

However, this study had some limitations; the large of missing data from medical records might lead to non-significant.

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Discussions (cont. 2)

Among DMHT patients There were significant associations between SBP

and CHF complication among diabetic hypertensive patients, obviously who had SBP ≥ 160 mmHg (OR = 1.56; 95%CI: 1.09-2.25; p=0.016)

This results were consistent with previous studies. Diabetes itself can cause heart failure by directly

damaging the heart muscle, but it can also lead to systolic heart failure indirectly by accelerating the development of CVD and high blood pressure.

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Discussions (cont. 3)

Furthermore, the comparison between levels of those associations among HT and DMHT patients presented that;SBP could be the risk factor, which provided

more significantly associated with occurring of CHF complication among DMHT patients than HT patients.

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Discussions (cont. 4)

StrengthNationally representative sampleReal situationsSaving for time and budget

LimitationInsufficient data and missing values in medical recordsInformation bias from data recording by medical staffsRecall bias from self-directed questionnaire by patients

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Conclusions

Systolic blood pressure was not significantly associated with congestive heart failure among HT patients.

On the other hand, there were significant associations between SBP and CHF complication among DMHT patients, obviously in the range of SBP ≥ 160 mmHg

(OR = 1.56; 95%CI: 1.09-2.25; p=0.016),particularly those who were equal to or more than

60 years of age along with sedentary occupations and smoking history.

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Recommendations

Studies regarding risk factors associated with complications, lead to preventing of mortality and disability among HT and DMHT patients.

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

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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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Thank Youfor

Your Attention