1. 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

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

3. 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

4. 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. Moreover, not much epidemiologic evidence http:// www. siamhealth.net

5. Objectives  To investigate the association between SBP and CHF among hypertensive patients in Thailand

6. 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

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)

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.

9. Results Fig. 1. The inclusion flow chart

10. Results ; Characteristics Gender BMI n= 38,429

11. 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

12. 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

13. Discussions This findings  The finding of this study showed that there were no significant associations between SBP and CHF complication among hypertensive patients (p = 0.223)  However, hypertensive patients who had high systolic blood pressure levels, were likely to obtained occurring of CHF complication.  These results likely presented the positive association but not significant difference

14. 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)  The recently study was conducted by Kathryn A., and colleagues found a positive association between SBP and HF risk. Among subjects with a SBP 130-139 mmHg, there was a significantly increased risk of HF as well as a linear trend in HF risk across normotensive SBP categories 6.

15. Discussions (cont. 3)  Strength Nationally representative sample Real situations (uncontrolled conditions) 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 bias Recall bias

16. Conclusions Systolic blood pressure was not significantly associated with congestive heart failure in hypertensive patients. Recommendations for the next study  Further research 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.

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 You for Your Attention