Skip Navigation

European Journal of Heart Failure 2005 7(5):784-786; doi:10.1016/j.ejheart.2004.04.021
This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Bener, A.
Right arrow Articles by Ghaffar, A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Bener, A.
Right arrow Articles by Ghaffar, A.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© 2005 European Society of Cardiology

Is hypertension a predictor for heart failure? A cross cultural comparison over a 10-year period

A. Benera,*, J. Al Suwaidib and A. Ghaffarc

a Department of Medical Statistics and Epidemiology, Hamad General Hospital, Hamad Medical Corporation University of Qatar, PO Box 3050, Doha-State of Qatar
b Department of Cardiology and Cardiovascular Surgery Hamad General Hospital, State of Qatar
c Global Forum for Health Research, Health Policy and Systems Specialist, WHO Geneva, Switzerland

* Corresponding author. Tel.: +974 439 3765/3766; fax: +974 439 3769. E-mail address: abener{at}hmc.org.qa abener99{at}yahoo.com


   Abstract
Top
 Abstract
1. Introduction
 2. Materials and methods
 3. Results and discussion
 References
 
This was a retrospective cohort study to assess the effect of hypertension (HTN) among Qatari and Asian patients admitted to the Hamad General Hospital in Qatar with heart failure (HF) and to identify risk factors that contribute to the development of HF in HTN patients in the State of Qatar. A total of 20,856 patients were treated during the 10-year period; 8446 were Qataris and 60% were male. Among the total Qatari patients admitted with HF (n = 2342), 52.4% had HTN. The incidence of HTN was slightly higher in males than in females (50.4 vs. 49.6%; p <0.001). Significantly more HTN patients had diabetes mellitus (DM) (p <0.001) and hypercholesterolemia (p <0.001). There was also a significant difference between Qatari and Asian HTN patients in respect of their age (p <0.001) and gender (p <0.001). Qatari hypertensive patients were more likely to have DM (p <0.001). HTN and DM were the most common risk factors for HF.

Key Words: Epidemiology • Hypertension • Heart failure • Ethnicity • Mortality • Morbidity

Received August 11, 2003; Revised January 22, 2004; Accepted April 13, 2004


   1. Introduction
Top
 Abstract
 1. Introduction
2. Materials and methods
 3. Results and discussion
 References
 
Hypertension (HTN) predicts an increased risk of developing heart failure [1–5]. The objective of this study was to assess the importance of HTN among Qatari and Asian patients admitted to hospital in Qatar with heart failure.


   2. Materials and methods
Top
 Abstract
 1. Introduction
 2. Materials and methods
3. Results and discussion
 References
 
This was a retrospective cohort study conducted at Hamad General Hospital between 1991 and 2001 using the coronary care unit (CCU) database, and included patients hospitalised with heart failure with or without HTN. The diagnostic classification of heart failure was made in accordance with the International Classification of Disease, ninth revision (ICD-9). Data, including blood pressures, were collected from the clinical records by the physician at the time of the patient's hospital discharge.

HTN was defined according to World Health Organization criteria [6] as systolic blood pressure (SBP) >140 mm Hg and/or diastolic blood pressure (DBP) >90mm Hg. Heart failure was defined as the simultaneous presence of at least two major criteria or one major criterion in conjunction with two minor criteria [5,7]. Diabetes mellitus (DM) was defined according to the use of oral medications or insulin for that condition. Patients were divided into current smokers, past smokers (cessation for >6 months and those who had never smoked.

Student's t-test was used to ascertain the significance of differences between mean values of two continuous variables and confirmed by the Mann–Whitney test. Chi-square was performed to test for differences in proportions of categorical variables between two or more groups. Logistic regression analysis was used to adjust for potential confounders and order the importance of risk factors for HTN.


   3. Results and discussion
Top
 Abstract
 1. Introduction
 2. Materials and methods
 3. Results and discussion
References
 
During the 10-year observation period, 20,856 patients were admitted to the CCU. Of these, 8446 were Qataris and 12,410 non-Qataris. Patients with heart failure and HTN were more likely to have DM and hypercholesterolemia (p<0.001). Patients with heart failure without HTN were more likely to be smokers.

Table 1 shows the clinical characteristics of Qatari and Asian patients with HTN and heart failure and Table 2 the treatment and in-hospital complications between Qataris and Asians. The prevalence of HTN was higher among Qataris compared to other Asian patients with heart failure (52.4% vs. 37.5%; P<0.001).


View this table:
[in this window]
[in a new window]

  		Table 1 Clinical characteristics of patients with heart failure among Qataris and other Asians

 


View this table:
[in this window]
[in a new window]

  		Table 2 Treatment and in-hospital morbidity and mortality among hypertensive Qataris and other Asians with heart failure

 
Table 3 presents the results of univariate and multivariate stepwise logistic regression analysis, adjusted for age, to identify factors independently associated with hypertension among patients with heart failure. Multivariate logistic regression revealed that female sex, Qatari nationality, breathlessness, DM, hypercholesterolemia, angina and calcium channel blocker use were associated with HTN amongst patients with heart failure.


View this table:
[in this window]
[in a new window]

  		Table 3 Variables associated with hypertension among patients with heart failure

 
These results suggest that HTN and DM are commonly associated with heart failure in Qatar. However, only about one-third of patients had overt evidence of coronary disease. The use of ACE inhibitors and beta-blockers reflects outdated clinical practice. These agents are now used in a much higher proportion of patients with heart failure.


   References
Top
 Abstract
 1. Introduction
 2. Materials and methods
 3. Results and discussion
 References
 

  1. McCullough P.A., Philbin E.F., Spertus J.A., Kaatz S., Sandberg K.R., Weaver W.D. Confirmation of a heart failure epidemic: findings from the Resource Utilization Among Congestive Heart Failure (REACH) Study. J Am Coll Cardiol (2002) 39:60–69.[Abstract/Free Full Text]
  2. Levy D., Larson M.G., Vasan R.S., Kannel W.B., Ho K.K. The progression from hypertension to congestive heart failure. JAMA (1996) 275:1557–1562.[Abstract/Free Full Text]
  3. Bener A., Al Suwaidi J., Al-Jaber K., Al-Marri S., Elbagi I.E. Epidemiology of hypertension and its associated risk factors in the Qatari population. J Hum Hypertens (2004) 18:529–530.[CrossRef][Web of Science][Medline]
  4. Vacacariono V., Holford T.R., Krumholz H.M. Pulse pressure and risk of myocardial infarction and heart failure in the elderly. J Am Coll Cardiol (2000) 36:130–138.[Abstract/Free Full Text]
  5. Haider A.W., Larson M.G., Franklin S.S., Levy D. Systolic blood pressure, diastolic blood pressure, and pulse pressure as predictors of risk for coronary heart failure in the Framingham heart study. Ann Intern Med (2003) 138:10–16.[Abstract/Free Full Text]
  6. World Health Organization. International society of hypertension guidelines for the management of hypertension. J Hypertens (1999) 17:151–182.[Web of Science][Medline]
  7. Dawber T.R., Meadors G.F., Moore F.E. Epidemiological approach to heart disease: the Framingham Study. Am J Public Health (1951) 41:279–286.[Free Full Text]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Postgrad. Med. J.Home page
J O'Loughlin, E Dugas, K Maximova, and N Kishchuk
Reporting of ethnicity in research on chronic disease: update
Postgrad. Med. J., November 1, 2006; 82(973): 737 - 742.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Bener, A.
Right arrow Articles by Ghaffar, A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Bener, A.
Right arrow Articles by Ghaffar, A.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?