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 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
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.
 Moreover, not much epidemiologic evidence
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)
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
Fig. 1. The inclusion flow chart
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
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
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
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 categories6.
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
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.
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
Thank You
for
Your Attention