Identifying Multiple Risk Factors of Hypertension for Reducing the Prevalence of Peripheral Arterial Disease in Rural Central Appalachia

Author Names and Emails

Olufeyisayo Odebunmi, East Tennessee State UniversityFollow
Sylvester Olubolu Orimaye, East Tennessee State UniversityFollow
Moboni Tosin Mokikan, East Tennessee State UniversityFollow
Adeola Olubukola Awujoola, East Tennessee State UniversityFollow
Adekunle Olumide Oke, East Tennessee State UniversityFollow
Amy Poole, East Tennessee State UniversityFollow
Timir Kumar Paul, East Tennessee State UniversityFollow
Terrie Walker, Ballad HealthFollow
Gerald Blackwell, Ballad Health
Arsham Alamian, East Tennessee State UniversityFollow
David W. Stewart, East Tennessee State UniversityFollow
Hadii Mohammed Mamudu, East Tennessee State UniversityFollow

Authors' Affiliations

Olufeyisayo Odebunmi, Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN. Sylvester Orimaye, Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN. Moboni Mokikan, Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN. Adeola Awujoola, Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN. Adekunle Oke, Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN Amy Poole, Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN Timir Paul, Department of Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, TN. Terrie Walker, Ballad Health, Johnson City, TN. Gerald Blackwell, Ballad Health, Johnson City, TN. Arsham Alamian, Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN. David Stewart, Department of Pharmacy Practice, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN. Hadii Mamudu, Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN.

Location

RIPSHIN MTN. ROOM 130

Start Date

4-12-2019 10:40 AM

End Date

4-12-2019 10:55 AM

Faculty Sponsor’s Department

Health Services Management & Policy

Name of Project's Faculty Sponsor

Dr. Hadii Mamudu

Classification of First Author

Graduate Student-Master’s

Type

Oral Presentation

Project's Category

Behavioral or Social Studies, Cardiovascular System, Hypertension

Abstract or Artist's Statement

Introduction

Hypertension occurs when there is persistent increase in the pressure of blood vessels in the body; this condition affects about 75 million people in the United States (U.S.). Hypertension is a major risk factor for Peripheral Artery Disease (PAD). PAD is a narrowing of the peripheral arteries in legs, stomach, arms and head regions of the body except the heart. Research has shown that hypertension can be life-threatening for patients with PAD. Moreover, research supports an evidence of a low threshold for blood pressure treatment in patients with PAD. Additionally, current American Heart Association guidelines recommend treating hypertension in patients with PAD to reduce the risk of other cardiovascular disease (CVD) comorbidities. In Central Appalachia, the rate of hypertension and the corresponding risk factors is higher than the national average. As such, this study examined the multiple risk factors of hypertension in patients with PAD within the Central Appalachian region.

Method

The study population consists of patients diagnosed with PAD in a large health system in Central Appalachia from 2008 to 2018. We extracted 13,455 patients with PAD from Electronic Medical Records (EMR) system using ICD- 9 and ICD-10 codes. The outcome variable of the study was hypertension in PAD patients. Explanatory variables included gender, age, and cardiovascular risk factors (myocardial infarction (MI), Body Mass Index (BMI), diabetes mellitus, smoking status, low-density lipoprotein, high-density lipoprotein, triglycerides, and hypercholesterolemia). Multivariable logistic regression was performed to assess the association between risk factors of hypertension in male and female PAD patients. All analyses were performed using SPSS version 24.

RESULTS

Of the total PAD patients in the study, 45.8% were females and 54.2% were males. Of these patients, 79.1%, 45.7% and 22.6% had hypertension, diabetes and a history of MI, respectively. Upon stratifying based on gender, the odds of hypertension in PAD female patients with a history of MI was approximately 5.4 times (OR: 5.4, CI : 1.80-16.21) and 2.6 times higher with diabetes (OR: 2.6, CI: 1.43-4.83). Whereas in PAD male patients, the odds of hypertension was 3.9 (OR: 2.6, CI: 1.61-9.21) and 2.6 times (OR: 2.6, CI: 1.43-4.83) higher in those with a history of MI and diabetes, respectively. Stratifying by MI, the odds of hypertension in PAD increased by 2.8 times in patients with diabetes (OR: 2.6, CI: 1.75-4.49). Stratifying by diabetes showed that the odds of hypertension in PAD increased by 4.7 times in patients with MI (OR: 4.7, CI: 1.32-17.07).

CONCLUSION

The study showed that odds of hypertension in PAD patients is increased in the presence of diabetes and history of MI in both genders. Therefore, controlling diabetes and myocardial infarction will have the greatest impact in reducing the likelihood of hypertension leading to decreased morbidity and mortality in patients with PAD.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.