Factors associated with blood pressure in hypertensive ...

Factors associated with blood pressure in hypertensive ...

Factors associated with blood pressure control in hypertensive patients and glycemic control in type 2 diabetes in rural community in central Thailand 5th Year Medical Students Phramongkutklao College of Medicine 1 Non-communicable disease (NCD) According to WHO heart disease, stroke, cancer, chronic respiratory diseases and diabetes, are the leading cause of mortality in the world.1

1. WHO, NCD factsheet 2015 2 Global DM Credit : IDF atlas, seventh edition 2015 3 DM in Thailand d on International Diabetes Federation (IDF) (2015) valence of diabetes in adult : 4,175,600

mate cases of undiagnosed diabetes patients : 2,223 4 Hypertension Global estimated prevalence = 1/3 of the global population.2 Caused 7.5 million death and 57 million disabled persons. In Thailand Estimated prevalence of HTN = 11 million people3 2. WHO, world health statistics 2015

3. National Health Security Office 5 Previous study Hypertension Prevalence of uncontrolled Hypertension Hospital setting : 35.7% 1 Community setting : 61.5% 2 Type 2 Diabetes Mellitus(T2DM) Prevalence of uncontrolled type 2 DM Hospital setting : 64.6% 1 3

Community setting : 38.9% 1. National Health Security Office of Thailand 2. Tangjatuporn et al.,2012 6 Objectives To determine prevalence and factors associated with uncontrolled blood sugar in type 2 diabetic patients

To determine prevalence and factors associated with uncontrolled blood pressure in hypertensive patients 7 Methods Questionnaire Associated factors HbA1c

Uncontrolled Diabetic patient T2DM Quantitative Cut point for uncontrolled patients s serum HbA1C > 7 mg% according to ADA1 goal American diabetes association. Standards of Medical Care in Diabetes2015: mmary of Revisions. Diabetes Care 2015; 1(supplement 1): S33-S40. Controlled Diabetic patient 8

Methods Hypertension Questionnaire Associated factors Quantitative Blood pressure JNC-81 goal for uncontrolled blood pressure was used to classify uncontrolled to controlled patients

1. Paul A. James, MD; Suzanne Oparil, MD; Barry L. Carter, PharmD; William C. Cushman, MD; Cheryl Dennison-Himmelfarb, RN, ANP, PhD; Joel Handler, MD5; et al.. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014; 311(5). Uncontrolled blood pressure Controlled blood pressure 9 Inclusion criteria Age > 20 years old History of hypertension and/or T2DM

Stay in community while data are collected Exclusion criteria Pregnancy or lactation Not consent Unable to communicate 10 Questionnaire Adapted from National Health Security Office 1 The eight-item Morisky Medication Adherence Scale (MMAS-8)2 (Cronbachs Alpha = 0.61) to describe the medication taking behavior of patients (Thai version)3

1. National Health Security Office, 2015 2. Morisky et al., 1986 3. Psychometric properties of the Thai version of the 8-item Morisky Medication Adherence Scale in patients with type 2 diabetes. 11 Morisky Medication Adherence Scale (MMAS-8) Is a questionnaire designed by Donald E. Morisky to predict patients drug compliance in 1986. 12

Ethical Approval This project was reviewed and approved by Institutional Review Board of Royal Thai Army Medical Department. Participants were given information about study procedure and an inform consent has been done. 13 Results 14 Study information Conducted in Tha Kradan,

Sanamchaiket, Chachoengsao. Study period : 21 25 Nov 2015 Total enrollment : 283 persons 15 Table 1 :General characteristics of study population (N=283) 16 Table 1 :General characteristics of study population (N=283) * 35.71 Baht = 1 US dollar as of 25 February

17 Prevalence of uncontrolled diseases Diabetes Uncontrolled : 54.4 % Controlled : 45.6 % Hypertension Uncontrolled : 42.2 % Controlled : 57.8 % 18 Multivariate Analysis to Determine Factors Associated with Glycemic Control in T2DM patients

Factors Controlled [ n(%) ] Uncontrolle d [ n(%) ] Adjusted odds ratio Normal weight 31 (52.5)

28 (48.5) 1 Obesity 34(47.2) 38(52.8) 2.36 No

48(56.5) 37(43.5) 1 Yes 22(28.9) 54(71.1) 2.35 95% CI

Pvalue 1.03 5.39 0.04 1.21 4.54 0.01 BMI (kg/m2)* Missed Medication

adjusted by age, duration of T2DM diagnosis, gender, education, patients' right, of adverse effect, regular doctor follow-up, poor attitude, dietary control *According to WHO. Appropriate body-mass index for Asian populations and its implications for policy and 19 intervention strategies. Multivariate Analysis to Determine Factors Associated with Blood Pressure Control in Hypertensive patients Factors Wellcontrolled [ n(%) ] Poorcontrolled

[ n(%) ] Adjusted odds ratio Adherence 36 (67.9) 17 (32.1) 1 Non adherence

31 (49.2) 32 (50.8) 2.19 95% CI P-value 1.02 4.67 0.044 MMAS-8

fter adjusted by gender, age, BMI*, co-morbid, dietary control *According to WHO. Appropriate body-mass index for Asian populations and its implications for policy and 20 intervention strategies. Discussion Our prevalence uncontrolled diabetes patients (54.4%) is higher than Siddiqui FJ et al1.s study(38.9%) possible reasons Dietary behavior Physical inactive Sedentary lifestyle 1. Siddiqui FJ et al. uncontrolled diabetes mellitus: prevalence and risk factors among people with type 2 diabetes mellitus in an Urban District of Karachi, Pakistan. Diabetes Res Clin Pract. 2015 Jan;107(1)

21 Discussion Compare to previous study on HTN prevalence(61.5%), this study have lower prevalence. A cohort study conducted by Ojji DB, et al1, revealed that 8.4% of hypertensive patients with co-morbid conditions tend to have poor hypertensive control. (We found no association). ji DB .Risk factor profile and comorbidities in 2398 patients with newly diagnosed ertension from the Abuja Heart Study, et al. Medicine (Baltimore) 2015. 22

Conclusion Appropriate medication usage and dietary promotion among rural population can enhance disease control. Primary healthcare and preventive medicine approaches can raise awareness among rural population. Recommend that further study should be conduct to gain better in possible factors. 23 Acknowledgement People of Baan Na Yao District Baan Na Yao health promotion hospital Sanamchaiket hospital

Col. Assistant Professor Dr. Ram Rangsin Lt. Col. Sarawut Jindarat Lt. Col. Tanongson Tienthavorn Lt. Col. Phunlerd Piyaraj Capt. Picha Suwannahitatorn Capt. Anupong Sirirungreung 2nd Lt. Ploypun Narindrarangkura 2nd Lt. Sirachat Nitchapanit 24 Acknowledgement 25

Thank you for your attention 26 Question? 27

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