A cross-sectional study on the prevalence of cardiovascular risk factors among patients hospitalized for complicated hypertension at two Jordanian hospitalsHijazeen, JK1; Al-Ma’aitah, OZ1; Abuznaid, MY, MD2; Abo.sharak, AN1; Al-Shar’, KA1.1 Sixth-year Medical Students, Faculty of Medicine, Mu’tah University, Karak, Jordan.2 Intern, Al-Bashir Teaching Hospital, Ministry of Health, Amman, Jordan.

Supervised by:

Prof. Imad FarjouDepartment of Pharmacology, Faculty of Medicine, Mu’tah University,

Karak, Jordan.

Source: http://news.bbc.co.uk/olmedia/1890000/images/_1890222_fight300.jpg

You still want

more data?

Worthy?

Systemic hypertension is a major public health problem worldwide.1

1. 1988 Joint National Committee. The 1988 report of the Joint Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1988; 148: 1023-1038.

Common?

1. World Health Report 2002: Reducing risks, promoting healthy life. Geneva, Switzerland:World Health Organization, 2002. http://www.who.int/whr/2002.

Worldwide prevalence estimates for hypertension may be as much as 1 billion individuals.1

Prevalence of Hypertension

[1] Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008. JAMA 2010; 303:2043.[2] Jaddou, H. Y., et al. "Hypertension prevalence, awareness, treatment and control, and associated factors: results from a national survey, Jordan."International journal of hypertension 2011 (2011).Source of photo: http://farm6.static.flickr.com/5252/5515887735_779fe1b150.jpg

Adults with hypertension

~29-31% 32.3%

So what?

Hypertension is a leading factor for coronary artery disease, congestive heart failure, stroke, renal disease, and retinopathy.1

The World Health Organization reports that suboptimal BP (>115 mm Hg SBP) is2: Responsible for 62% of cerebrovascular disease

and 49% of ischemic heart disease, with little variation by sex.

The number one attributable risk for death throughout the world.

1. 1988 Joint National Committee. The 1988 report of the Joint Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1988; 148: 1023-1038.

2. World Health Report 2002: Reducing risks, promoting healthy life. Geneva, Switzerland:World Health Organization, 2002. http://www.who.int/whr/2002.

Ministry of Heatlh, Jordan:

Mortality Data in Jordan, 2009 .

Source: “Mortality Data in Jordan, 2009.» , Ministry of Health, Jordan. http://www.moh.gov.jo/MOH/Files/Publication/al%20seha%20net.pdf

Objective

The aim of this study was: To find out some epidemiological

data on hypertensive patients admitted with complications of hypertension

Explore cardiovascular risk factors among these patients.

Explore factors in the patients’ history that predispose for poor control of blood pressure.

Design of Our Study

A c

ross-s

ecti

on

al stu

dy.

Source of photo: Google Maps, https://maps.google.com/maps/ms?msid=208944260277323386787.0004da027e4d066d3cd48&msa=0&ll=31.600969,36.201841&spn=1.24681,2.469177

October,

2011

March, 2013

Interview admitted patients who fulfill the following criteria: Established

diagnosis of hypertension.

Admitted for complications of hypertension.

Conscious and oriented.

The Patient Encounter

Source of photo: http://www.dailymail.co.uk/debate/article-1163064/HARRIET-SERGEANT-Why-does-NHS-hate-elderly-much.html

Study subjects (n=182)

Study subjects (n=182)

The mean age of males was 64.9 yr ± 12.4 SD (n=106) . The mean age of females was 67.0 yr ± 11.8 SD (n=76). The overall mean age of patients was 65.1 yr ± 12.1 SD (n=182).

Age groups of patients (n=182)

The mean age of middle-aged patients was 52.0 yr ± 5.9 SD (n=55) .

The mean age of old-aged patients was 71.8 yr ± 8.9 SD (n=127).

Sex Distribution of Age Groups (n=182)

Marital Status (n=180)

Educational level (n=178)

Monthly Family Income (JD) (n=174)

Sex Distribution of Occupation (n=175)

Provisional Diagnosis on Admission (n=175)

Sex D

istr

ibu

tion

of

the

Pro

vis

ion

al D

iag

nosis

on

A

dm

issio

n (

n=

175)

Sex D

istr

ibu

tion

of

the

Pro

vis

ion

al D

iag

nosis

on

A

dm

issio

n (

n=

175)

Old age (>=60)

Middle age (40-59)

Duration since Diagnosis (n=178)

• Mean duration since diagnosis = 10.37 +/- 7.5 years

Number of Drugs (n=162)

Antihypertensive Drugs

Drug abbreviations: ACEI, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor blocker; BB, beta-blocker; CCB, calcium channel blocker.

Risk Factor

s

Excessive salt intake

Excessive fat intake

Smoking

Dyslipidemia

Diabetes

Family History

Amount of Salt in Diet (n=180)

Amount of Fat in Diet (n=179)

Cigarettes Smoking (n=182)

Sex Distribution of Cigarettes Smoking (n=182)

Males (n=106) Females (n=75)0%

20%

40%

60%

80%

100%

120%

63.2%

17.1%

36.8%

82.9%

Yes No

1-20 21-40 >400.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%55.1%

28.2%

16.7%

Number of Cigarettes Smoked per Day (n=78)

Diagnosis of Hyperlipidemia (n=178)

Diagnosis of Diabetes (n=181)

Sex Distribution of Diabetes (n=181)

Males (n=106) Females (n=75)0%

20%

40%

60%

80%

100%

120%

50% 56%

50% 44%

Yes No

p value=.426

Family History of Hypertension (1st degree relatives) (n=175)

Sex Distribution of Family History of Hypertension (1st degree relatives) (n=175)

Males (n=102) Females (n=73)0%

20%

40%

60%

80%

100%

120%

24% 30%

76% 70%

Negative Positive

p value=.328

Family History of Death due to Cardiovascular Diseases (MI or CVA) (n=163)

Sex distribution of Family History of Death due to Cardiovascular Diseases (MI or CVA) (n=163)

Males (n=96) Females (n=67)0%

20%

40%

60%

80%

100%

120%

52% 51%

48% 49%

Positive Negative

p value = 0.867

Conclusions

Hypertension was more common in old-aged patients (≥ 6o yr) (69.8%) than middle-aged patients (40-59 yr) (30.2%).

Most patients were chronic hypertensives on drug treatment (≥ 10 years: 54%).

The percentage of patients on mono-, double, triple, and quadruple therapy was 43.8%, 32.1%, 17.9%, and 4.3% respectively.

Conclusions

Most men were retired (34%) and manual workers (22.6%). While most women were housewives (89.3%) and farmers (3.9%).

87.1% of patients were either illiterate or had a school-level education.

Conclusions

Regarding dietary habits of patients, 52.2% of patients restricted their salt intake, and 64.3% of patients restricted their fat intake.

The percentage of patients who smoked was 44.0%. Smoking was approximately four times more common among males than females (63.2% vs 17.1%).

Family history of HTN, and death to cardiovascular disease (MI or CVA) was present in 73.7%, and 48.5% of patients respectively.

Recommendations

In order to improve control of BP among hypertensive patients on medication and to reduce incidence of complications, it is recommended that they should: Decrease their salt intake, as well as fat intake

especially if they are obese, hyperlipidemic, or diabetic.

Stop smoking because it is important to help control their BP.

because of uncontrolled BP…

your Blood Pressure!- Steve Jobs

control

No restriction of salt

intake….. 48%No restriction of fat intake…..

36%Smoked…………………………..

44%

The majority of patients were either illiterate or had a school-level education, therefore, we hope that this should be taken into consideration when counseling or designing educational materials targeting hypertensive patients.

Recommendations

... وبتألك عليكي بتسلم حبة... أميحبة...

The majority of patients had a family history of hypertension, so we recommend screening for hypertension among first-degree relatives of hypertensive individuals.

Recommendations

There is no need then to quit smoking then!

Congrats! You have a normal blood pressure!

Photo: Courtesy of Anas Rawashdeh, https://www.facebook.com/anas.rwashdeh.1

Recommendations:

A further study could be conducted so as to explore the knowledge, attitudes, and

perceptions of patients toward blood pressure control and cardiovascular risk factors.

: e قائًال علق الضغط دواء يأخذ أن يرفض الذي المرضى أحد

إشي كل مش الدوا؟ أوخذ بدي ليش

... يصير مكتوب؟بده

Complications?

Targets? How? Care?

Thank you!!!

Source of photo: Tareq Al-Amour Photography, https://www.facebook.com/TareqAlAmourPhotography