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
1
Outlines
Background
 Objectives
 Materials and Methods
 Results
 Discussions
 Conclusions

2
Background
http://isp.swanih.org

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://www medical device network.com
3
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.
4
Objectives

To investigate the association between
SBP and CHF among hypertensive
patients in Thailand
5
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
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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, BMI, Smoking, Lipid profiles,
and ECG results
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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
Results
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)
9
Results ; Characteristics
Gender
Age
36.6 %
13 %
Male
63.4 %
< 50 yrs.
≥ 50 yrs.
Female
87%
n= 38,478
n= 38,429
7.20%
29.50%
44.60%
55.50%
63.30%
n= 32,482
BMI
Underweight
Normal
Overweight
n= 37,285
Occupation
Non-sedentary
occupation
Sedentary
occupation
Results ; Characteristics (cont. 2)
6.30%
19%
25.90%
Optimal (< 120)
Pre-hypertension (120-139)
Hypertension I (140-159)
48.80%
Hypertension II (≥ 160)
(*Joint National Committee on Prevention, Detection, Evaluation,
and Treatment of High Blood Pressure (JNC); 7th report, 2009.)
n= 38,345
Systolic blood pressure*
13.9 %
No
Yes
86.1 %
Smoking History
n= 20,626
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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
12
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.
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.
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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 bias from data recording by medical staffs
15
Conclusions
Systolic blood pressure was not significantly
associated with congestive heart failure in
hypertensive patients.
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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
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Thank You
for
Your Attention