1. 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 University 1

2. Outlines  Background  Objectives  Materials and Methods  Results  Discussions  Conclusions  Recommendations 2

3. 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. http://isp.swanih.org http://www medical device network.com 3

4. 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. http:// www. siamhealth.net 4

5. 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. 5

6. Materials and Methods  Study design Cross-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 6

7. 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) 7

8. 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. 8

9. Results 9 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

10. Results ; Characteristics 10

11. Results ; Characteristics (cont. 2) 11

12. 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

13. 13 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

14. Discussions Among 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. 14

15. 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. 15

16. 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. 16

17. Discussions (cont. 4)  Strength Nationally representative sample Real situations Saving for time and budget  Limitation Insufficient data and missing values in medical records Information bias from data recording by medical staffs Recall bias from self-directed questionnaire by patients 17

18. 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. 18

19. 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. 19

20. 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 20

21. Thank You for Your Attention