Blood Pressure Parameters and the Development of Congestive Heart Failure among Hypertensive Patients at Kiambu County Hospital, Kenya

Abstract

Introduction: Global incidence of heart failure is on increase. Heart failure has been shown to be on the increase with 1-3% admission rates globally and a 3-7% admission rate in the African hospitals. Hypertension (HTN) has been shown to play a pivotal role in the evolution and syndrome of heart failure where it is mostly non- ischemic in origin yet there are few studies on the association of the individual blood parameters and heart failure. Objective: The study assessed the individual blood pressure parameters as prognosticators of congestive heart failure (CHF) in hypertensive patients. Method: A retrospective study was carried out at Kiambu County Hospital, on 205 heart failure patients who met the Framingham Criteria. The parameters observed included the time of onset of CHF, systolic/ diastolic blood pressure, pulse pressure and their duration to the development of CHF. Multivariable cox proportional hazard regression models were used to determine the effects of individual blood pressure parameters relative to the onset of CHF. Results: Overall, 205 patients were eligible for the study. Median time to CHF was estimated to be 4 years (range: 1-18), median age of CHF development was 65.7 years with a 68.8% female preponderance. Pulse pressure of 55- 60 mm Hg (AHR: 2.21; 95%CI: 1.16-4.21), hypertension duration of 5-10 years (AHR: 0.14; 95%CI: 0.088-0.223) and over 10 years (AHR: 0.023; 95%CI: 0.010-0.050) were significantly associated with the development of CHF. Conclusion: Pulse pressure is a better prognosticator of CHF in hypertensive patients with a hazard ratio of 2.2 times more likely in patients with a pulse pressure of 55- 60 mmHg than those below 55mm Hg.