Prevalence, awareness, treatment and control of hypertension in Malaysia: a national study of 16,440 subjects

Effectiveness of Valsartan's Single-Pill Combination Therapies on Blood Pressure Control in Hypertensive Patients: Malaysian Single-Centre Real-World Experience

Background

Uncontrolled hypertension can cause cardiovascular disease and is an important public health issue. Single-pill combination (SPC) therapies possess combined blood pressure (BP)-lowering effect and may improve compliance to treatment. This study assessed the effectiveness of valsartan (Val)-based SPC therapies in achieving BP control in hypertensive patients.

Methods

This was a retrospective study. Data were extracted from the hybrid medical records of patients from the Institut Jantung Negara (IJN), Malaysia. Adults with established diagnosis of hypertension and on prescription of Val-based SPC therapies as part of routine medical care from 1 January 2013 to 31 December 2018, with ≥ 1 year of follow-up were included. Primary endpoint was proportion of patients achieving therapeutic BP control (BP < 140/90 mmHg). Secondary outcomes included change from baseline (CFB) in systolic BP (SBP) and diastolic BP (DBP), and subgroup analysis was based on baseline SBP categories and presence of diabetes.

Results

Study included 409 hypertensive patients. The mean (standard deviation [SD]) age of the population was 65.1 (10.6) years old, with male predominance (61.6%). Proportion of patients achieving target BP between baseline and follow-up were 57.0% (P < 0.001). Mean CFB in SBP and DBP were recorded as 19.52 mmHg and 7.47 mmHg, respectively. Over half of the patients achieved the target BP in all subgroups categorised by SBP at baseline, except the subgroup of SBP 160 mmHg-179 mmHg. SPC therapies were continued in 97.3% of patients at 1-year follow-up.

Conclusion

Patients using Val-based SPC therapies had significant reduction in BP with good tolerability, with 57% of patients achieving target BP over a prolonged 1-year follow-up period. Uptake of SPC therapy is warranted to improve patient care and outcomes in hypertension.

Prevalence and determinants of medications non-adherence among patients with uncontrolled hypertension in primary care setting in Sarawak, Malaysia: A cross-sectional study

INTRODUCTION

Non-adherence to antihypertensive medications is a leading cause of uncontrolled hypertension and its complications. However, data on the factors associated with non-adherence to antihypertensive medications in the communities of Sarawak, Malaysia, are limited. This study aimed to examine the prevalence and determinants of medication non-adherence among patients with uncontrolled hypertension.

METHOD

A cross-sectional study was conducted using the systematic sampling method in four government primary healthcare clinics in Sarawak. A self-administered questionnaire was used to obtain socio-demographic data and evaluate non-adherence. Blood pressure was measured, and relevant clinical variables were collected from medical records. Multivariate logistic regression was used to determine the determinants of medication non-adherence.

RESULTS

A total of 488 patients with uncontrolled hypertension were enrolled in this study. The prevalence of medication non-adherence was 39.3%. There were four predictors of medication non-adherence among the patients with uncontrolled hypertension: tertiary educational level (odds ratio [OR]=4.21, 95% confidence interval [CI] = 1.67-10.61, P=0.010), complementary alternative medication (0R=2.03, 95% CI=1.12-3.69, P=0.020), non-usage of calcium channel blockers (0R=1.57, 95% CI=1.02-2.41, P=0.039) and 1 mmHg increase in the systolic blood pressure (0R=1.03, 95% CI=1.00-1.05, P=0.006).

CONCLUSION

Because of the high prevalence of medication non-adherence among patients with uncontrolled hypertension, primary care physicians should be more vigilant in identifying those at risk of being non-adherent. Early intervention should be conducted to address non-adherence for blood pressure control.

Prevalence and determinants of unmet needs for hypertension care among the older population in Selangor: cross-sectional study

BACKGROUND

Hypertension is a major cause of morbidity and mortality worldwide. Although multiple studies have assessed the prevalence of hypertension among older people, no study has examined the unmet need for hypertension care among older people in Malaysia. This study uses the hypertension care cascade to identify the prevalence of unmet needs for hypertension care and their determinants among the older population in Selangor.

METHODS

This is a cross-sectional study involving a total of 1204 participants recruited from different areas in Selangor. A face-to-face interview was conducted using the Bahasa Malaysia version of the Japan Gerontological Evaluation Study questionnaire. The inclusion criteria were Malaysians aged ≥ 60 years who could converse in Bahasa Malaysia.

RESULTS

Among the 637 participants with hypertension, 18% (117) had not been previously screened but were found to have BP ≥ 140/90 mmHg, 21% (136) were undiagnosed, 3% (17) were untreated, 42% (267) were treated with antihypertensive medication but still had high blood pressure, and 16% (100) had hypertension that was controlled with medication. The hypertension care cascade demonstrates that 18% (117) of those with hypertension had never been screened for hypertension; 26% (136/520) of those who were screened never received a diagnosis; 4% (17/384) of those who were diagnosed did not receive treatment; and 73% (267/367) of those who were treated did not reach the threshold for control. The prevalence of total unmet needs was 84% (537/637). Statistically significant determinants of having any unmet need for hypertension care were smoking status and medical history, with adjusted odds ratios and 95% confidence intervals (CIs) in the multivariate analysis of 0.5 (95% CI: 0.3-0.9) for being a smoker, 2.8 (95% CI: 1.1-6.9) for having a history of stroke and 1.6 (95% CI: 1.0-2.5) for having a history of diabetes mellitus.

CONCLUSIONS

The prevalence of unmet need for hypertension care among the older population in Selangor is 84% (537/637), which is alarmingly high. This study highlights where and how much of the loss of care for hypertension happens in the care cascade and provides insight into the efforts required to improve effective service coverage to manage the increasing burden of hypertension associated with population ageing.

Effects of a school-based intervention to reduce cardiovascular disease risk factors among secondary school students: A cluster-randomized, controlled trial

BACKGROUND

Cardiovascular diseases (CVDs) are the number cause of death worldwide. In Ghana CVD has been the leading cause of death since 2001. The prevalence of CVD risk factors among adolescents in Ghana has been increasing. This study seeks to develop, implement and evaluate the effects of a behavioral modification intervention program to reduce CVD risk factors among secondary school students in Brong Ahafo, Ghana.

METHODS

A cluster-randomized controlled trial was conducted with schools as clusters over a period of six-months with pre and post intervention evaluations. Participants were public secondary school students (14-19 years) from four schools in Brong Ahafo, Ghana. Students in the intervention group were trained by the researchers whereas those of the control group received no intervention. The intervention included health education and physical activity modules. Follow-up data using same questionnaire were collected within two weeks after the intervention was completed. Intention-to-treat analysis was performed after replacing missing values using the multiple imputation method. The generalized linear mixed model (GLMM) was used to assess the effects of the intervention study.

RESULTS

The GLMM analyses showed the intervention was effective in attaining 0.77(p<0.001), 0.72(p<0.001), 0.47(p<0.001), 0.56(p<0.001), and 0.39(p = 0.045) higher total physical activity, fruits, vegetables, seafood, and water scores respectively for the intervention group over the control group. The intervention was also significant in reducing -0.15(p<0.001),-0.23(p<0.001),-0.50(p<0.001),-0.32(p<0.001),-0.90(p<0.001),-0.87(p<0.001),-0.38(p<0.001), -0.63(p<0.001), -1.63(p<0.001), 0.61(p<0.001), and -1.53(p = 0.005) carbohydrates, fats and oils, fried eggs, fried chicken, carbonated drinks, sugar, sweet snacks, salted fish, weight, BMI, and diastolic BP. The odds of quitting alcohol use in the intervention group were 1.06 times more than the control group. There was no significant effect on reducing smoking and systolic BP.

CONCLUSION

There is an urgent need for the intervention program to be integrated into the existing curriculum structure of secondary school schools. Implementing the intervention will allow for longer and more consistent impact on the reduction of CVD risk factors among secondary school students.

Community burden of hypertension and treatment patterns: An in-depth age predictor analysis: (The Rural Community Risk of Non-Communicable Disease Study - Nyive Phase I)

BACKGROUND

This study aimed to describe the burden, treatment patterns and, age threshold for predicting hypertension among rural adults in Nyive in the Ho Municipality of the Volta Region, Ghana.

METHODS

A population-based cross-sectional study design was employed. A total of 417 adults aged 20 years and above were randomly selected from households within the Nyive community. The WHO STEPwise approach for non-communicable diseases risk factor surveillance (STEPS) instrument was used to obtain socio-demographic and clinical information including age, gender, educational background, marital status, and occupation as well as hypertension treatment information. Blood pressure was measured using standard methods. The risk of hypertension and the critical age at risk of hypertension was determined using binary logistic regression model and the receiver-operator characteristics (ROC) analysis.

RESULTS

The direct and indirect age-standardized hypertension prevalence was higher in males (562.58/487.34 per 1000 residents) compared to the females (489.42/402.36 per 1000 residents). The risk of hypertension among the study population increased by 4.4% (2.9%-5.9% at 95% CI) for one year increase in age while the critical age at risk of hypertension was >39 years among females and >35 years among males. About 64(46.72%) of the hypertensive participants were not on treatment whereas only 42(30.66%) had their blood pressure controlled.

CONCLUSION

Rural hypertension is high among adults in Nyive. The critical age at risk of hypertension was lower among males. The estimated annual increase of risk of hypertension was 4.7% for females and 3.1% for males. High levels of undiagnosed and non-treatment of hypertension and low levels of blood pressure control exist among the rural folks.

Challenges for Diagnostic Clarity for Post-stroke Cognitive Impairment and Behavioural Issues in Middle-Income Countries: Case Studies From Malaysia

Following stroke, individuals require ongoing screening, diagnosis and monitoring for cognitive impairment. Services and policies around these vary widely between settings, and reports from many countries highlight persistent under-diagnosis of cognitive impairment in the months and years after stroke. Missed and delayed diagnosis of post-stroke cognitive impairment, including dementia, are important factors in shaping the experiences of people so affected and their family members, especially in low- and middle-income countries. Drawing upon ethnographic research conducted in Malaysia, this article draws upon three case studies to examine the continued health-seeking behaviour after the appearance of salient cognitive and behavioural symptoms that occurred after stroke. Findings highlight the challenges in getting formal diagnostic clarity for cognitive and behavioural symptoms in a rural setting within a middle-income country. No study participants sought help for memory or cognitive problems, partly due to limited lay awareness of cognitive impairment but more significantly due to health service factors. Despite their elevated risk for dementia, participants were not monitored for cognitive impairment during any follow-up care in various health facilities. Furthermore, caregivers' attempts to seek help when behavioural issues became untenable were met with multiple health system barriers. The journey was complicated by the meanings attached to the reactions towards cognitive symptoms at the community level. We suggest that strategies seek to increase the awareness of post-stroke cognitive and behavioural symptoms, and incorporate clear treatment pathways into the long-term care plans of community-dwelling stroke survivors.

Self-reported diabetes, hypertension and hypercholesterolemia among older persons in Malaysia

AIM

The objective of this study is to determine the prevalence of self-reported diabetes, hypertension and hypercholesterolemia among older persons in Malaysia and their associated factors.

METHODS

The study used data from the National Health and Morbidity Survey in 2018. It was a cross-sectional study with two-staged stratified cluster sampling design. In total, 3977 adults aged ≥60 years were selected for this study. Respondents were interviewed face to face using a structured questionnaire. Self-reported diabetes, hypertension or hypercholesterolemia was defined as having ever been told they have these diseases by a medical doctor or paramedic. Data were analyzed using SPSS version 25. The multiple logistic regression model was used to examine the factors associated with the prevalence of self-reporting.

RESULTS

The prevalence of self-reported diabetes, hypertension and hypercholesterolemia among older persons in Malaysia were 27.7%, 51.1% and 41.8% respectively. Presence of other comorbidities and being obese showed higher odds for all three diseases. Indians, unemployed, inactive had higher odds for diabetes. Other Bumiputras, unemployed, non-smoker, obese and inactive had higher odds for hypertension. Non-smoker had higher odds for hypercholesterolemia.

CONCLUSIONS

Health promotion, vigilance, attention and services targeting on the associated factors should be strengthened for older persons in Malaysia to ensure healthy aging. Geriatr Gerontol Int 2020; 20: 79-84.

Descriptive cross-sectional study on knowledge, awareness and adherence to medication among hypertensive patients in a tertiary care center, Eastern Sri Lanka

Introduction:

Hypertension is one of the common non-communicable diseases and public health problem among developed and developing countries. The lack of knowledge and awareness on hypertension and poor adherence of medication are a major challenge to control hypertension and prevent its complications. Our study aimed to assess the knowledge, awareness of hypertension and adherence to medication among hypertensive patients attending the medical clinics of a tertiary care center, Eastern Province of Sri Lanka.

Methods:

A descriptive cross-sectional study was conducted among hypertensive patients to assess knowledge, awareness of hypertension and adherence to medication in medical clinics in a tertiary care for 6 months duration. Data were collected by using pretested and validated Hypertension Facts Questionnaire. Their medication adherence and the reasons for nonadherence were studied using Medication Adherence Scale. Data were analyzed using SPSS (version 18) analytical package and the chi-square test was performed. The scoring system was used to categorize the level of knowledge and awareness of hypertension among patients.

Results:

The majority of patients had moderate-to-high knowledge (101, 65.8%) about hypertension and had moderate-to-high awareness (111, 73.2%) on hypertension. Even though, 134 (87.6%) patients knew that they have hypertension, and 108 (70.6%) patients did not know their blood pressure value at the time of diagnosis. Most of the patients (90, 58.8%) had good drug adherence, and most of them (141, 92.1%) thought that taking medicine plays a key role to control their blood pressure. The main reasons for nonadherence of medication were forgetfulness (39, 32%) and expenses (46, 35.4%). The knowledge and awareness about hypertension among respondents were significantly associated with educational level (p < 0.05)

Conclusion:

Most of the patients had adequate knowledge on the risk factors and complications of hypertension. But they were unaware about their disease status, and their diagnosis, target organ damage and recent blood pressure values. The drug adherence was reasonably adequate. The main reasons for nonadherence of medication were forgetfulness and expenses.

The prevalence of hypertension and influencing factors among the employees of a university hospital

Background

Hypertension is a serious disease with increasing worldwide prevalence, leading to life-threatening complications.

Methods

This cross-sectional study was carried out in a university hospital. The Occupational Health and Safety Unit data concerning the health examinations of employees were used to determine the prevalence of hypertension in a university hospital and to define the relationship between hypertension and sociodemographic and occupational parameters. Logistic regression analyses were performed for the variables having a significant association with high blood pressure.

Results

The data generated during the periodic examination of 3,480 (92%) of all employees (3,780) were analyzed. The prevalence of hypertension was 14.8%. The prevalence of hypertension was found to be 13.5%, 13.9%, and 23.7% among physicians, non-physician healthcare personnel and officers respectively. The logistic regression model revealed a statistically significant correlation between hypertension and male gender, age and BMI.

Conclusion

The prevalence of hypertension was highest among staff members. Special programs would facilitate the diagnosis, control, and prevention of high blood pressure among the high-risk groups, especially men, the elderly and the obese hospital employees.

Incidence of hypertension among Asian Indians: 10 year follow up of the Chennai Urban Rural Epidemiology Study (CURES-153)

AIMS

There are very few studies on incidence of hypertension from developing countries. We report on the incidence of hypertension and its risk factors in Chennai city in southern India.

METHODS

Participants were 1691 individuals from the Chennai Urban Rural Epidemiology Study (CURES) cohorts who did not have hypertension (normotensive n = 878, prehypertension n = 813) at baseline and who were followed for a median of 9.0 years. During the follow-up, 41 with missing blood pressure values were excluded, leaving 1650 individuals for the present analysis. Incidence rates of hypertension and predictors of progression to prehypertension and/or hypertension were estimated using Cox proportional hazards model.

RESULTS

During the follow-up period, 426 out of 1650 individuals developed hypertension, giving an overall incidence of hypertension of 28.7(95%CI 26.1-31.5) per 1000 person-years. Individuals with dysglycemia at baseline had higher incident rates of hypertension. Collectively, four modifiable risk factors [pre-hypertension, dysglycemia, central obesity and physical inactivity] accounted for 87.2% of the population attributable risk of incident hypertension.

CONCLUSIONS

Higher body weight, BMI, age and dysglycemia were associated with an increased risk of incident hypertension. Prehypertension, dysglycemia, central obesity and physical inactivity accounted for 87% of incident hypertension.

Improvement of nutritional intake for the low-income urban dwellers with hypertension in Malaysia

Objective:

To ascertain the effect of dietary practice modification and a peer-support home blood pressure monitoring program on the nutritional intake (macronutrients and micronutrients), blood pressure and biochemical profiles of hypertension patients in a low-income community setting.

Methods:

This is a pre- and post-measurement intervention study conducted in low-income community housing projects in Kuala Lumpur, Malaysia. A total of 90 participants aged 18 years and above with hypertension received intervention. The participants were divided into small groups and received instructions on the use of home blood pressure measurement. They also attended a series of talks on dietary intake modification and exercise demonstration for the first six months (active phase). In another 6 months (maintenance phase), they received only pamphlet and SMS reminders. Their anthropometry, blood pressure, dietary, and biochemical parameter changes were measured at baseline, 6 months, and 12 months of intervention.

Results:

Macronutrients and micronutrients showed a significant improvement at the end of 12-month dietary intervention. The energy, carbohydrate, protein, total fat, sodium, and potassium are showing significant reduction from baseline to end of the 12-month intervention. There is no significant reduction in blood pressure. Fasting blood glucose, renal sodium, triglyceride, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol showed a significant improvement, after controlling for age and reported physical activity.

Conclusion:

The intervention improved the nutritional intake and biochemical profiles of the low-income urban population with hypertension. This promising result should be replicated in a larger scale study.

Prevalence, awareness and control of hypertension in Malaysia from 1980-2018: A systematic review and meta-analysis

BACKGROUND

Hypertension is a common public health problem worldwide and is a well-known risk factor for increased risk of cardiovascular diseases, contributing to high morbidity and mortality. However, there has been no systematic review and meta-analysis of a multiethnic population such as that of Malaysia.

AIM

To determine the trend in prevalence, awareness and control rate of hypertension in Malaysia.

METHODS

Systematic searches were conducted in six databases (PubMed, Scopus, Ovid, CINAHL, Malaysian Medical Repository and Malaysia Citation Index) for articles published between 1980 and 2018. Two authors reviewed the studies and performed quality assessment and data extraction independently. Pooled estimates of hypertension prevalence, awareness and control rate were calculated using the DerSimonian-Laird random-effects model. Subgroup and sensitivity analyses were performed.

RESULTS

We included 56 studies involving a total of 241796 participants. The overall pooled prevalence of hypertension aged ≥ 18 years was 29.7%. The prevalence of hypertension was the lowest in the 1980s (16.2%, 95% confidence interval (CI): 13.4, 19.0), increasing up to 36.8% (95%CI: 6.1, 67.5) in the 1990s, then decreasing to 28.7% (95%CI: 21.7, 35.8) in the 2000s and 26.8% (95%CI: 21.3, 32.3) in the 2010s. The prevalence of awareness was 51.4% (95%CI: 46.6, 56.3), while 33.3% (95%CI: 28.4, 38.2) of those on treatment had achieved control of their blood pressure.

CONCLUSION

In Malaysia, three in ten adults aged ≥ 18 years have hypertension, while four in ten adults aged ≥ 30 years have hypertension. Five out of ten people are aware of their hypertension status and only one-third of those under treatment achieved control of their hypertension. Concerted efforts by policymakers and healthcare professionals to improve awareness and control of hypertension should be of high priority.

Cardio-metabolic risk factors in Tunisia: state of the art

Cardiometabolic risk factors in Tunisia are growing fast. The main risk factor is metabolic syndrome which is a global health issue in both developing and developed countries. It is resulting from a new phase of epidemiological transition characterised by ageing and an increase in non-communicable diseases. It is common in both genders with some disparities between urban and rural regions, educational levels and social classes. Hypertension and diabetes are also additional risk factors predicting alarming mortality rates. We propose here a review of the determinants of metabolic syndrome in Tunisia and the overall cardiometabolic risk factors.

Clustering and Tracking the Stability of Biological CVD Risk Factors in Adolescents: The Malaysian Health and Adolescents Longitudinal Research Team Study (MyHeARTs)

Background: Cardiovascular disease (CVD) risk factors tend to cluster and progress from adolescence to young adulthood. Reliable and meaningful clustering of CVD risk factors is essential to circumvent loss of information. Tracking adverse and high-risk profiles of adolescents is hoped to curb CVD progression later in life. The study aims to investigate the clustering of biological CVD risk factor among adolescents in Malaysia and the transitions between clusters over time.

Method: The Malaysian Health and Adolescents Longitudinal Research Team study (MyHeARTs) examined school students aged 13 in 2012 and re-examined them in 2014 and 2016. In a two-stage stratified cluster sampling, 1,361 students were recruited, of which, 1,320 had complete data. In the follow-up, there were 881 and 637 students in 2014 and in 2016, respectively. Pearson's correlation coefficients were used to identify and remove highly correlated CVD risk factors. All risk factors were standardized into z-scores. The hierarchical and non-hierarchical (k-means) cluster analyses were used to classify students into high, medium and low risk clusters in each screening year. The tracking and stability of cluster transitions through cross-classification were enumerated with Pearson's inter-age correlations and percentages.

Results: Three significant clusters of high, medium and low risk groups were derived from the clustering of eight biological CVD risk factors. The transitions between risk clusters from one screening year to the other were categorized as either stagnant, improved or adverse. The number of students who had adverse transitions increased from 15.5% (13–15 year) to 19.5% (15–17 year), 13.8 to 18.2% among the girls and 19.9 to 22.8% among the boys. For girls, the number of them who remained at high risk over the two transition periods were about the same (13.6 vs. 13.8%) whereas for boys, the percentage reduced from 14.6 to 12.3%.

Conclusion: Over time, more than 12% of adolescents remained in the high risk cluster. There were sizable adverse transitions over time as more adolescents appear to be shifting toward an increased risk of having CVD. Collaborative and constant measures should be taken by parents, school, health promotion boards and policy makers to curb the multiplicative effect of clustering CVD risk factors among adolescents.

Non-communicable diseases among low income adults in rural coastal communities in Eastern Sabah, Malaysia

Background

Rural coastal communities in Sabah are still overly represented in the hardcore poor economic status. The aim of this study was to determine the prevalence of hypertension, diabetes mellitus and hypercholesterolemia among adults, in relation to economic status.

Methods

A cross-sectional study using stratified random sampling was conducted in seven coastal villages in Semporna, Sabah: Kabogan Laut, Salimbangun, Pekalangan, Pokas, Tampi-Tampi Timbayan, Sum Sum and Selinggit. Socio-demographic data were obtained via interviewer administered questionnaires in Sabah Malay creole. Anthropometric measurements, blood pressure, fasting blood glucose and blood lipids were obtained.

Results

A total of 330 adults (133 males, 197 females) completed the study. Mean age was 43.7 ± 15.8 years. Most participants (87%) were living below the Poverty Line Income. Median per capita household income was RM83.33/month (≈ USD20/month). The number of newly diagnosed cases of hypercholesterolemia was 40.6%, diabetes mellitus was 5.8%, and hypertension was 24.5%. Adults from the hardcore poor economic status (household income ≤RM760/month (≈USD183/month) were the most represented in those who did not have a blood pressure, blood sugar and blood lipids check in the 12 months preceding the study (Χ², p < 0.01). Adults from hardcore poor economic status were also the most represented in undiagnosed hypertension and uncontrolled blood pressure among those diagnosed (Χ², p = 0.013). Among diabetics from the hardcore poor group, the undiagnosed fasting blood glucose was 11.2 ± 4.5 compared to 5.1 ± 0.6 mmol/L for diagnosed diabetics (p < 0.001). Among hypercholesterolemics from the hardcore poor group, total cholesterol and LDL cholesterol values were significantly higher in the undiagnosed group compared to the diagnosed group (p < 0.001).

Conclusion

Many people in this rural coastal community were unaware that they had high cholesterol level (40.6%) and elevated blood pressure (24.5%). Routine health check is not common among low income adults in rural coastal communities in Semporna. The findings suggest public health initiatives should emphasize access to and the necessity of routine health checks for those aged 40 years.

Milk Powder Fortified with Potassium and Phytosterols to Decrease the Risk of Cardiovascular Events among the Adult Population in Malaysia: A Cost-Effectiveness Analysis

This study evaluated the cost-effectiveness of the consumption of a milk powder product fortified with potassium (+1050.28 mg/day) and phytosterols (+1200 mg/day) to lower systolic blood pressure and low-density lipoprotein cholesterol, respectively, and, therefore, the risk of myocardial infarction (MI) and stroke among the 35-75-year-old population in Malaysia. A Markov model was created against a do-nothing option, from a governmental perspective, and with a time horizon of 40 years. Different data sources, encompassing clinical studies, practice guidelines, grey literature, and statistical yearbooks, were used. Sensitivity analyses were performed to evaluate the impact of uncertainty on the base case estimates. With an incremental cost-effectiveness ratio equal to international dollars (int$) 22,518.03 per quality-adjusted life-years gained, the intervention can be classified as very cost-effective. If adopted nationwide, it would help prevent at least 13,400 MIs, 30,500 strokes, and more than 10,600 and 17,100 MI- and stroke-related deaths. The discounted cost savings generated for the health care system by those who consume the fortified milk powder would amount to int$8.1 per person, corresponding to 0.7% of the total yearly health expenditure per capita. Sensitivity analyses confirmed the robustness of the results. Together with other preventive interventions, the consumption of milk powder fortified with potassium and phytosterols represents a cost-effective strategy to attenuate the rapid increase in cardiovascular burden in Malaysia.

Prevalence, awareness and control of hypertension in Malaysia 1980 – 2017: A Systematic Review and Meta-Analysis.. [DOI: 10.1101/625004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background

Hypertension is a common public health problem worldwide and is a well-known risk factor for increased risk of cardiovascular diseases, contributing to high morbidity and mortality. However, there is no systematic review and meta-analysis that has been done in a multi-ethnic population like Malaysia. This systematic review aims to determine the trend in prevalence, awareness and control of hypertension in Malaysia.

Methods

Systematic searches were conducted in PubMed, Scopus, Ovid, Cumulative Index to Nursing and Allied Health Literature, Malaysian Medical Repository and Malaysia Citation Index published between 1980 and 2017. All original articles in English were included. Studies included were those on adults aged 18 years and above. Studies of prevalence in children and adolescents and pregnancy related hypertension were excluded. Two authors independently reviewed the studies, carried out data extraction and performed quality assessment. Heterogeneity between studies and publication bias was assessed and effect size was pooled by the random effect model.

Results

Fifty-six studies with a total of 241,796 subjects were included. The prevalence of hypertension throughout Malaysia varied (I2= 99.3%). The overall pooled prevalence of hypertension over the past 4 decades was 28.2% in adults aged 18 years and older (95% CI: 26.1 – 33.3) and the prevalence in those 30 years and older was 40.0% (95% CI: 35.3-44.8).

For subgroup analysis, the prevalence of hypertension in male aged 18 and above was 31.4% (95% CI: 26.5 - 36.2) and 27.8% in female (95% CI: 20.7 – 34.9). The prevalence of hypertension among the ethnic groups aged 18 years and above were 37.3% in Malays (95% CI: 32.9 – 41.7); 36.4% in Chinese (95% CI 31.6 - 41.2) and 34.8% in Indians (95% CI: 31.2-38.4). The prevalence of hypertension was the lowest in the 1980s (16.2%, 95% CI: 13.4-19.0%), increases up to 36.8% in the 1990s (95% CI: 6.1-67.5), then came down to 28.7% (95% CI: 21.7-35.8) in the 2000s and 29.2% (95% CI: 24.0-34.4) in the 2010s. The prevalence of awareness was 38.7% (95% CI: 31.7 – 45.8) whereas the control of hypertension of those on treatment was 33.3% (95% CI: 28.4 – 38.2).

Conclusion

Three in 10 adults aged 18 years old and above have hypertension, whereas four in 10 adults aged 30 years old and above have hypertension. Four out of 10 are aware of their hypertension status and only one-third of them who were under treatment achieved control of their hypertension. Concerted efforts by policymakers and healthcare professionals to improve the awareness and control of hypertension should be of high priority.

Knowledge, attitude and practice regarding hypertension among residents in a housing area in Selangor, Malaysia

Background and aims

Hypertension is becoming a global epidemic and threat to the world population. This cross-sectional study was carried out at a housing area in Selangor, Malaysia to study the knowledge, attitude and practice (KAP) regarding hypertension among the residents.

Methods

A total of 110 respondents aged 18 years old and above were selected by convenience sampling. Data was collected using a structured interviewer-guided questionnaire with Likert-scale choices of answers.

Results

All respondents were Malay with the mean age of 41 years [Standard Deviation (SD)=11.828]. The total mean and SD of knowledge, attitude and practice scores were 74.33 (SD=6.25), 44.22 (SD=5.05) and 27.55 (SD=2.86), respectively. There were significant positive correlations between knowledge with attitude (r=+0.393; p<0.001) and practice (r=+0.378; p<0.001). However, there was no significant correlation between attitude and practice (r=+0.120; p=0.212). There were significant fair positive correlations between age with knowledge (r=+0.402; p<0.001), attitude (r=+0.265; p=0.005) and practice (r=+0.337; p<0.001) regarding hypertension. Meanwhile, gender, educational level, employment status and family history had no significant association with knowledge, attitude and practice regarding hypertension.

Conclusion

This study revealed that KAP regarding hypertension were associated with age, but not with other socio-demographic characteristics studied. The awareness, prevention and control programs of hypertension in their community should be increased, so that the residents could enjoy and maintain the healthy lifestyle.

Factors associated with the severity of hypertension among Malaysian adults

High blood pressure is a worldwide problem and major global health burden. Whether alone or combined with other metabolic diseases, high blood pressure increases the risk of cardiovascular disease. This study is a secondary data analysis from the National Health and Morbidity Survey 2015, a population-based study that was conducted nationwide in Malaysia using a multi-stage stratified cluster sampling design. A total of 15,738 adults ≥18-years-old were recruited into the study, which reports the prevalence of hypertension stages among adults in Malaysia using the JNC7 criteria and determinants of its severity. The overall prevalence of raised blood pressure was 66.8%, with 45.8% having prehypertension, 15.1% having Stage 1 hypertension, and 5.9% having Stage 2 hypertension. In the multivariate analysis, a higher likelihood of having prehypertension was observed among respondents with advancing age, males (OR = 2.74, 95% CI: 2.41-3.12), Malay ethnicity (OR = 1.21, 95% CI: 1.02-1.44), lower socioeconomic status, and excessive weight. The factors associated with clinical hypertension (Stages 1 and 2) were older age, rural residency (Stage 1 OR = 1.22, Stage 2 OR = 1.28), Malay ethnicity (Stage 2 OR = 1.64), diabetes (Stage 2 OR = 1.47), hypercholesterolemia (Stage 1 OR = 1.34, Stage 2 OR = 1.82), being overweight (Stage 1 OR = 2.86, Stage 2 OR = 3.44), obesity (Stage 1 OR = 9.01, Stage 2 OR = 13.72), and lower socioeconomic status. Almost 70% of Malaysian adults are at a risk of elevated blood pressure. The highest prevalence was in the prehypertension group, which clearly predicts a future incurable burden of the disease. Public health awareness, campaigns through mass and social media, and intervention in the work place should be a priority to control this epidemic.

Prevalence, Awareness, Treatment and Control of hypertension in the Malaysian population: findings from the National Health and Morbidity Survey 2006-2015

Hypertension is strongly associated with chronic diseases such as myocardial infarction, stroke, heart failure, and renal failure. The objective of this study is to determine the trend of prevalence, awareness, treatment, and control of hypertension among Malaysian population since 2006 to 2015. The study used the data from National Health and Morbidity Survey (NHMS) 2006, 2011, and 2015. It was a cross-sectional with two-stage stratified random sampling throughout Malaysia for eligible respondents 18 years old and above. Respondents were interviewed face to face and blood pressure was recorded as the average reading from two electronic pressure monitoring measurements. Data was analyzed using the Complex sample module in SPSS Version 20. The prevalence of hypertension in Malaysia was 34.6% (95% CI: 33.9, 35.3) in 2006, 33.6% (95% CI: 32.6, 34.6) in 2011 and 35.3% (95% CI: 34.5, 36.3) in 2015. Awareness of hypertension in 2006, 2011, and 2015 was 35.6% (95% CI: 34.6, 36.6), 40.7% (95% CI: 39.3, 42.1), and 37.5% (95% CI: 36.1, 38.9) respectively. The trend of receiving treatment from 2006 to 2015 was 78.9% (95% CI: 77.5, 80.2) to 83.2% (95% CI: 81.3, 84.8). The control of hypertension increased significantly from 27.5% (95% CI: 25.9, 29.2) in 2006 to 37.4% (95% CI: 35.3, 39.5) in 2015. Despite higher proportions receiving treatment over time, the control of hypertension remained below 40% since NHMS 2006 until 2015. The strategies to further reduce the prevalence and increase awareness of hypertension should be enhanced particularly among the targeted age group to ensure early detection, treatment, and control thus preventing from long-term complications.

A qualitative exploration of hypertensive patients' perception towards quality use of medication and hypertension management at the community level

Objective

This study aimed to explore hypertensive patients' perspectives on quality use of medication and issues related to hypertension management at the community level in Malaysia.

Methods

Focus groups discussion was employed in this qualitative study. A total of 17 hypertensive patients were purposively recruited. Three focus group discussions with semi-structured interview were carried out at Flat Desa Wawasan, Penang. All the conversations were audio recorded, transcribed verbatim and thematically analysed.

Results

Three major themes were developed, including medication adherence among hypertensive patients, self-management of hypertension and patients' knowledge towards hypertension. Poor medication adherence was found and different strategies were taken to overcome the barriers towards adherence. Use of herbal and traditional therapies was perceived as alternative method in controlling blood pressure instead of taking antihypertensive medication. The participants were found to have poor knowledge on side effect and mechanism of action of hypertensive medication.

Conclusions

The misconception about the side effect of antihypertensive medication has led to poor adherence among the participants. Lack of knowledge on targeted blood pressure level has led to poor blood pressure monitoring among the participants. Health awareness program and counselling from health care professional should be advocated among the hypertensive patients in addressing the above gaps.

Nutrition label experience, obesity, high blood pressure, and high blood lipids in a cohort of 42,750 Thai adults

INTRODUCTION

Nutrition labels have been promoted for nearly two decades in Thailand to educate people about healthy eating and to combat nutrient-related non-communicable diseases (NCDs). But little is known about how nutrition labels are experienced and whether they are linked with better health. Our objective was to investigate the associations between nutrition label experience, obesity and nutrient-related NCDs in Thai consumers.

METHODS

A cross-sectional study was undertaken with a nationwide cohort of 42,750 distance learning Thai adult students enrolled in an Open University in 2013. We measured exposure as nutrition label experience (read, understand, use). Health outcomes were high blood pressure, high blood lipids, and high Body Mass Index (overweight at risk and obesity). Multivariate logistic regression was used to determine the association between nutrition label experience and health outcome adjusting for sociodemographic attributes, physical activity, smoking, and alcohol intake.

RESULTS

Frequent nutrition label use varied by cohort attributes and health outcomes and was least for those with low physical activity and high blood pressure. Being male, older, an urban resident or with low physical activity was associated with increasing high blood pressure and high blood lipids. Compared to those who read, understand and use nutrition labels, participants who did not (read, understand, and use), were more likely to report high blood pressure (Adjusted Odds Ratio 1.33; 1.17-1.51), high blood lipids (AOR 1.26; 1.14-1.39), and obesity (AOR 1.23; 1.13-1.33), but were not more likely to be overweight at risk (AOR 1.06; 0.97-1.16).

CONCLUSIONS

We found cross-sectional associations between low nutrition label experience and increased likelihood of high blood pressure, high blood lipids, and obesity among Thai adults. Nutrition label education should be promoted as part of a public health approach to appropriate food choices and better lifestyles to reduce obesity and nutrient-related NCDs.

Vasorelaxant properties of Vernonia amygdalina ethanol extract and its possible mechanism

CONTEXT

Vernonia amygdalina Del. (VA) (Asteraceae) is commonly used to treat hypertension in Malaysia.

OBJECTIVE

This study investigates the vasorelaxant mechanism of VA ethanol extract (VAE) and analyzes its tri-step FTIR spectroscopy fingerprint.

MATERIALS AND METHODS

Dried VA leaves were extracted with ethanol through maceration and concentrated using rotary evaporator before freeze-dried. The vasorelaxant activity and the underlying mechanisms of VAE using the cumulative concentration (0.01-2.55 mg/mL at 20-min intervals) were evaluated on aortic rings isolated from Sprague Dawley rats in the presence of antagonists.

RESULTS

The tri-step FTIR spectroscopy showed that VAE contains alkaloids, flavonoids, and saponins. VAE caused the relaxation of pre-contracted aortic rings in the presence and absence of endothelium with EC₅₀ of 0.057 ± 0.006 and 0.430 ± 0.196 mg/mL, respectively. In the presence of Nω-nitro-l-arginine methyl ester (EC₅₀ 0.971 ± 0.459 mg/mL), methylene blue (EC₅₀ 1.203 ± 0.426 mg/mL), indomethacin (EC₅₀ 2.128 ± 1.218 mg/mL), atropine (EC₅₀ 0.470 ± 0.325 mg/mL), and propranolol (EC₅₀ 0.314 ± 0.032 mg/mL), relaxation stimulated by VAE was significantly reduced. VAE acted on potassium channels, with its vasorelaxation effects significantly reduced by tetraethylammonium, 4-aminopyridine, barium chloride, and glibenclamide (EC₅₀ 0.548 ± 0.184, 0.158 ± 0.012, 0.847 ± 0.342, and 0.304 ± 0.075 mg/mL, respectively). VAE was also found to be active in reducing Ca²⁺ released from the sarcoplasmic reticulum and blocking calcium channels.

CONCLUSIONS

The vasorelaxation effect of VAE involves upregulation of NO/cGMP and PGI₂ signalling pathways, and modulation of calcium/potassium channels, and muscarinic and β₂-adrenergic receptor levels.

Awareness of diabetes, hypertension, and hypercholesterolemia in Malaysia

BACKGROUND

Policy interventions for cardiovascular diseases require individual awareness of ailments. Such awareness is also key to individuals making changes to their lifestyle and dietary habits. The present study investigated the association of sociodemographic, health, and lifestyle factors with the awareness and prevalence of three ailments: diabetes, hypertension, and hypercholesterolemia.

METHODS

Data were obtained from the Malaysia Non-Communicable Disease Surveillance-1. Logistic regressions were estimated and odds ratios of exposure variables calculated.

RESULTS

Diabetes awareness was associated with work hours, age, family history of illnesses, and ethnicity. Individuals with diminished hypertension awareness included those who were younger, without family history of illnesses, not obese, working more hours, and not adhering to a healthy diet. Low awareness of hypercholesterolemia was associated with younger age, lower education level, living in rural areas, female gender, no family history of illnesses, non-obesity, and minority ethnic background. Prevalence generally had the same pattern of association with the exposure variables.

CONCLUSIONS

Various sociodemographic and health and lifestyle characteristics were associated with diabetes, hypertension, and hypercholesterolemia awareness in Malaysia, albeit with varying outcomes. Therefore, programs focusing on lifestyle improvements should be targeted at high-risk subgroups, such as individuals working longer hours and young adults, who are less likely to be aware of their health risk factors.

STRUCTURAL CHARACTERISTICS AND ANTIHYPERTENSIVE EFFECTS OF ANGIOTENSIN-I-CONVERTING ENZYME INHIBITORY PEPTIDES IN THE RENIN-ANGIOTENSIN AND KALLIKREIN KININ SYSTEMS

BACKGROUND

The commercially available synthetic angiotensin-I-converting enzyme (ACE) inhibitors are known to exert negative side effects which have driven many research groups globally to discover the novel ACE inhibitors.

METHOD

Literature search was performed within the PubMed, ScienceDirect.com and Google Scholar.

RESULTS

The presence of proline at the C-terminal tripeptide of ACE inhibitor can competitively inhibit the ACE activity. The effects of other amino acids are less studied leading to difficulties in predicting potent peptide sequences. The broad specificity of the enzyme may be due to the dual active sites observed on the somatic ACE. The inhibitors may not necessarily competitively inhibit the enzyme which explains why some reported inhibitors do not have the common ACE inhibitor characteristics. Finally, the in vivo assay has to be carried out before the peptides as the antihypertensive agents can be claimed. The peptides must be absorbed into circulation without being degraded, which will affect their bioavailability and potency. Thus, peptides with strong in vitro IC50 values do not necessarily have the same effect in vivo and vice versa.

CONCLUSION

The relationship between peptide amino acid sequence and inhibitory activity, in vivo studies of the active peptides and bioavailability must be studied before the peptides as antihypertensive agents can be claimed.

Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-Based Studies From 90 Countries

BACKGROUND

Hypertension is the leading preventable cause of premature death worldwide. We examined global disparities of hypertension prevalence, awareness, treatment, and control in 2010 and compared secular changes from 2000 to 2010.

METHODS

We searched MEDLINE from 1995 through 2014 and supplemented with manual searches of retrieved article references. We included 135 population-based studies of 968 419 adults from 90 countries. Sex- and age-specific hypertension prevalences from each country were applied to population data to calculate regional and global numbers of hypertensive adults. Proportions of awareness, treatment, and control from each country were applied to hypertensive populations to obtain regional and global estimates.

RESULTS

In 2010, 31.1% (95% confidence interval, 30.0%-32.2%) of the world's adults had hypertension; 28.5% (27.3%-29.7%) in high-income countries and 31.5% (30.2%-32.9%) in low- and middle-income countries. An estimated 1.39 (1.34-1.44) billion people had hypertension in 2010: 349 (337-361) million in high-income countries and 1.04 (0.99-1.09) billion in low- and middle-income countries. From 2000 to 2010, the age-standardized prevalence of hypertension decreased by 2.6% in high-income countries, but increased by 7.7% in low- and middle-income countries. During the same period, the proportions of awareness (58.2% versus 67.0%), treatment (44.5% versus 55.6%), and control (17.9% versus 28.4%) increased substantially in high-income countries, whereas awareness (32.3% versus 37.9%) and treatment (24.9% versus 29.0%) increased less, and control (8.4% versus 7.7%) even slightly decreased in low- and middle-income countries.

CONCLUSIONS

Global hypertension disparities are large and increasing. Collaborative efforts are urgently needed to combat the emerging hypertension burden in low- and middle-income countries.

Effects of a Community-Based Healthy Lifestyle Intervention Program (Co-HELP) among Adults with Prediabetes in a Developing Country: A Quasi-Experimental Study

BACKGROUND

The prevalence of type 2 diabetes among Malaysian adults has increased by more than two folds over the past two decades. Strategies to collaborate with the existing community partners may become a promising channel for wide-scale dissemination of diabetes prevention in the country. The objectives of this study were to determine the effects of community-based lifestyle interventions delivered to adults with prediabetes and their health-related quality of life as compared to the usual care group.

METHODS

This was a quasi-experimental study conducted in two sub-urban communities in Seremban, Malaysia. A total of 268 participants with prediabetes aged between 18 to 65 years old were assigned to either the community-based lifestyle intervention (Co-HELP) (n = 122) or the usual care (n = 146) groups. The Co-HELP program was delivered in partnership with the existing community volunteers to incorporate diet, physical activity, and behaviour modification strategies. Participants in the Co-HELP group received twelve group-based sessions and two individual counselling to reinforce behavioural change. Participants in the usual care group received standard health education from primary health providers in the clinic setting. Primary outcomes were fasting blood glucose, 2-hour plasma glucose, and HbA1C. Secondary outcomes included weight, BMI, waist circumference, total cholesterol, triglyceride, LDL cholesterol, HDL cholesterol, systolic and diastolic blood pressure, physical activity, diet, and health-related quality of life (HRQOL).

RESULTS

An intention-to-treat analysis of between-groups at 12-month (mean difference, 95% CI) revealed that the Co-HELP participants' mean fasting plasma glucose reduced by -0.40 mmol/l (-0.51 to -0.28, p<0.001), 2-hour post glucose by -0.58 mmol/l (-0.91 to -0.24, p<0.001), HbA1C by -0.24% (-0.34 to -0.15, p<0.001), diastolic blood pressure by -2.63 mmHg (-3.79 to -1.48, p<0.01), and waist circumference by -2.44 cm (-4.75 to -0.12, p<0.05) whereas HDL cholesterol increased by 0.12 mmol/l (0.05 to 0.13, p<0.01), compared to the usual care group. Significant improvements were also found in HRQOL for both physical component (PCS) by 6.51 points (5.21 to 7.80, p<0.001) and mental component (MCS) by 7.79 points (6.44 to 9.14, p<0.001). Greater proportion of participants from the Co-HELP group met the clinical recommended target of 5% or more weight loss from the initial weight (24.6% vs 3.4%, p<0.001) and physical activity of >600 METS/min/wk (60.7% vs 32.2%, p<0.001) compared to the usual care group.

CONCLUSIONS

This study provides evidence that a culturally adapted diabetes prevention program can be implemented in the community setting, with reduction of several diabetes risk factors and improvement of HRQOL. Collaboration with existing community partners demonstrated a promising channel for the wide-scale dissemination of diabetes prevention at the community level. Further studies are required to determine whether similar outcomes could be achieved in communities with different socioeconomic backgrounds and geographical areas.

TRIAL REGISTRATION

IRCT201104106163N1.

Angiotensin-I Converting Enzyme (ACE) Inhibitory and Anti-Hypertensive Effect of Protein Hydrolysate from Actinopyga lecanora (Sea Cucumber) in Rats

Food protein hydrolysates are known to exhibit angiotensin converting enzyme (ACE) inhibitory properties and can be used as a novel functional food for prevention of hypertension. This study evaluated the ACE inhibitory potentials of Actinopyga lecanora proteolysate (ALP) in vivo. The pre-fed rats with ALP at various doses (200, 400, 800 mg/kg body weight) exhibited a significant (p ≤ 0.05) suppression effect after inducing hypertension. To determine the optimum effective dose that will produce maximal reduction in blood pressure, ALP at three doses was fed to the rats after inducing hypertension. The results showed that the 800 mg/kg body weight dose significantly reduced blood pressure without noticeable negative physiological effect. In addition, there were no observable changes in the rats’ heart rate after oral administration of the ALP. It was concluded that Actinopyga lecanora proteolysate could potentially be used for the development of functional foods and nutraceuticals for prevention and treatment of hypertension.

Genetic Analysis of the Atrial Natriuretic Peptide Gene Polymorphisms among Essential Hypertensive Patients in Malaysia

Background. Atrial natriuretic peptide (ANP) considerably influences blood pressure regulation through water and sodium homoeostasis. Several of the studies have utilized anonymous genetic polymorphic markers and made inconsequent claims about the ANP relevant disorders. Thus, we screened Insertion/Deletion (ID) and G191A polymorphisms of ANP to discover sequence variations with potential functional significance and to specify the linkage disequilibrium pattern between polymorphisms. The relationships of detected polymorphisms with EH with or without Type 2 Diabetes Mellitus (T2DM) status were tested subsequently. Method. ANP gene polymorphisms (I/D and A191G) were specified utilizing mutagenically separated Polymerase Chain Reaction (PCR) in 320 subjects including 163 EH case subjects and 157 controls. Result. This case-control study discovered a significant association between I/D polymorphisms of ANP gene in EH patient without T2DM. However, the study determined no association between G191A polymorphisms of ANP in EH with or without T2DM. In addition, sociodemographic factors in the case and healthy subjects exhibited strong differences (P < 0.05). Conclusion. As a risk factor, ANP gene polymorphisms may affect hypertension. Despite the small sample size in this study, it is the first research assessing the ANP gene polymorphisms in both EH and T2DM patients among Malaysian population.

Brunei epidemiological stroke study: patterns of hypertension and stroke risk

OBJECTIVES

Hypertension is the most important known risk factor for cardiovascular diseases. A cross-sectional study was conducted in Brunei Darussalam to estimate the prevalence of hypertension and its association with socioeconomic and life-style factors and impact on stroke incidence.

METHODS

Five thousand and sixty-three participants aged above 18 years from 2103 randomly selected households in the Brunei-Muara district of Brunei Darussalam were surveyed. Hypertension was defined as mean SBP at least 140 mmHg, DBP at least 90 mmHg, or taking antihypertensive medication and blood pressure was measured twice. Logistic regression models are used to analyze the association between hypertension/medication for hypertension and sex, age, overweight, education, smoking, family history of hypertension, and employment.

RESULTS

A total of 48.3% [95% confidence interval (CI): 46.9-49.7%] of all respondents were identified as hypertensive. Prevalence of hypertension was higher in men (52.8%; 95% CI: 50.7-54.9%) compared to women (45.0%; 95% CI: 43.2-46.8%) and women seek treatment more often than men. Age, overweight, lower levels of education, and a family history of high blood pressure are positively associated with the prevalence of hypertension. The prevalence of overweight (57.3%) and obesity (23.7%) is high and the attributable risk of hypertension for stroke is large.

CONCLUSION

The prevalence of hypertension in Brunei is high in both women and men. Information campaigns and prevention programs are needed to be able to cope with the increasing problem of hypertension and resulting diseases like stroke in Brunei in the near future.

Prevalence, awareness, treatment, control and socio demographic determinants of hypertension in Malaysian adults

BACKGROUND

Hypertension is the leading cardiovascular risk factor globally as well as in Malaysia. This study aimed to estimate the prevalence, awareness, treatment, control and the socio demographic determinants of hypertension among Malaysian adults.

METHOD

The analytic sample consisted of 11,288 adults aged ≥ 30 years recruited at baseline in 2007-2011 from the REDISCOVER Study which is an ongoing, prospective cohort study involving 18 urban and 22 rural communities in Malaysia. Socio-demographics, anti-hypertensive treatment details and an average of at least two blood pressure measurements were obtained.

RESULTS

The age-adjusted prevalence was 42.0 % (CI: 40.9-43.2) and was higher in men [43.5 % (CI: 41.2-45.0)] than women [41.0 % (CI: 39.8-42.3)]. Participants from rural areas (APR: 1.12, CI: 1.04-1.20); aged at least 40-49 years (APR: 1.86, CI: 1.62-2.14); who were overweight (APR: 1.24, CI: 1.15-1.34) and obese (APR: 1.54, CI: 1.43-1.6) were more likely to have hypertension. The Indigenous ethnic group was less likely to be aware (APR: 0.81, CI: 0.69-0.92) and to be on treatment (APR: 0.66, CI: 0.55-0.79). Those in rural areas were less likely to have their hypertension controlled (APR: 0.61, CI: 0.49-0.75). On the other hand, control was more likely in females (APR: 1.25, CI: 1.01-1.54) and Indigenous group (APR: 1.64, CI: 1.19-2.25).

CONCLUSION

Hypertension is common in the Malaysian adults. The control of hypertension has increased over the years but is still quite low. Public health measures, as well as individual interventions in primary care are crucial to reduce their risk of developing complications.

Obesity can predict and promote systemic inflammation in healthy adults

BACKGROUND

To find out the differences on biomedical data between obese and non-obese participants, and to identify risk factors associated with systemic inflammation in healthy Palestinian adults.

METHODOLOGY

A cross-sectional study involved 105 apparently healthy adults. Interview questionnaire was used to collect personal information. Participants were excluded if they suffered from acute or chronic inflammatory diseases, or continued using medicines, which might affect the biomedical results.

RESULTS

In association with increased Body Mass Index (BMI), the obese group displayed significant higher markers including: interleukin 6 (IL-6), high sensitivity C reactive protein (hs-CRP), total cholesterol (TC), systolic blood pressure (SBP), and diastolic blood pressure (DBP). Obese group in association with increased waist circumference (WC) was higher significantly in inflammatory markers (IL-6, hs-CRP), lipid profile (TC) and triglyceride (TG), and blood pressure (SBP, DBP). A tertile of a feature of systemic inflammation (hs-CRP) was created, by Ordinal Logistic Regression, after adjusting for the age, gender, smoking habits, physical activity pattern, father and mother's health history; risk factors were the increased BMI [OR: 1.24] (95% CI: 1.005-1.548, P=0.050), IL-6 [OR: 3.35] (95% CI: 1.341-8.398, P=0.010), DBP [OR: 1.19] (95% CI: 1.034-1.367, P=0.015), and reduced Adiponectin [OR: 0.59] (95% CI: 0.435-0.820, P=0.001). Finally, BMI correlated with IL-6 and hs-CRP (r=0.326, P=0.005; r=0.347, P<0.001; respectively), and hs-CRP correlated with IL-6 (r=0.303, P=0.010), and inversely with Adiponectin (r=-0.342, P=0.001).

CONCLUSION

The increased level of IL-6 and reduced Adiponectin, which strongly associated with obesity, indicated that having high BMI is a useful marker in association with IL-6 and further developed systemic inflammation.

Socioeconomic status and hypertension: a meta-analysis

BACKGROUND

The relationship between socioeconomic status (SES) and hypertension has been studied in a number of reviews. However, the impact of SES on hypertension has been reported in several studies with conflicting results.

METHODS

A systematic search was performed in PubMed, Proquest and Cochrane databases for observational studies on hypertension prevalence and SES, published in English, until March 2014. Hypertension was defined as a mean SBP of at least 140 mmHg or a DBP of at least 90 mmHg, or use of antihypertensive medication. The inverse variance method with a random-effects model was used to pool the risk estimates from the individual studies. Data abstraction was conducted independently by two authors.

RESULTS

Among the 2404 references, 51 studies fulfilled the inclusion criteria. An overall increased risk of hypertension among the lowest SES was found for all three indicators: income [pooled odds ratio (OR) 1.19, 95% confidence interval (CI) 0.96-1.48], occupation (pooled OR 1.31, 95% CI 1.04-1.64) and education (pooled OR 2.02, 95% CI 1.55-2.63). The associations were significant in high-income countries, and the increased risk of hypertension for the lowest categories of all SES indicators was most evident for women, whereas men revealed less consistent associations.

CONCLUSION

Low SES is associated with higher blood pressure, and this association is particularly evident in the level of education. It is important to identify and monitor hypertension to reduce the risk of this disease among the most vulnerable groups in different countries and among different societies.

Impact of a Workplace Health Promotion Program on Employees' Blood Pressure in a Public University

INTRODUCTION

Workplace health promotion is important in the prevention of non-communicable diseases among employees. Previous workplace health programs have shown benefits such as lowered disease prevalence, reduced medical costs and improved productivity. This study aims to evaluate the impact of a 6-year workplace health promotion program on employees' blood pressure in a public university.

METHODS

In this prospective cohort study, we included 1,365 employees enrolled in the university's workplace health promotion program, a program conducted since 2008 and using data from the 2008-2013 follow-up period. Participants were permanent employees aged 35 years and above, with at least one follow up measurements and no change in antihypertensive medication during the study period. Baseline socio-demographic information was collected using a questionnaire while anthropometry measurements and resting blood pressure were collected during annual health screening. Changes in blood pressure over time were analyzed using a linear mixed model.

RESULTS

The systolic blood pressure in the hypertension subgroup decreased 2.36 mmHg per year (p<0.0001). There was also significant improvement in systolic blood pressure among the participants who were at risk of hypertension (-0.75 mmHg, p<0.001). The diastolic blood pressure among the hypertensive and at risk subgroups improved 1.76 mmHg/year (p<0.001) and 0.56 mmHg/year (p<0.001), respectively. However, there was no change in both systolic and diastolic blood pressure among participants in the healthy subgroup over the 6-year period.

CONCLUSION

This study shows that continuing participation in workplace health promotion program has the potential to improve blood pressure levels among employees.

Hypertension in Malaysia: An Analysis of Trends From the National Surveys 1996 to 2011

This study aimed to determine trends in prevalence, awareness, and control of hypertension in Malaysia and to assess the relationship between socioeconomic determinants and prevalence of hypertension in Malaysia.The distribution of hypertension in Malaysia was assessed based on available data in 3 National Health and Morbidity Surveys (NHMSs) and 1 large scale non-NHMS during the period of 1996 to 2011. Summary statistics was used to characterize the included surveys. Differences in prevalence, awareness, and control of hypertension between any 2 surveys were expressed as ratios. To assess the independent associations between the predictors and the outcome variables, regression analyses were employed with prevalence of hypertension as an outcome variable.Overall, there was a rising trend in the prevalence of hypertension in adults ≥30 years: 32.9% (30%-35.8%) in 1996, 42.6% (37.5%-43.5%) in 2006, and 43.5% (40.4%-46.6%) in 2011. There were significant increase of 32% from 1996 to 2011 (P < 0.001) and of 29% from 1996 to 2006 (P < 0.05), but only a small change of 1% from 2006 to 2011 (P = 0.6). For population ≥18 years, only a 1% increase in prevalence of hypertension occurred from the 2006 NHMS (32.2%) to the 2011 NHMS (32.7%) (P = 0.25). A relative increase of 13% occurred in those with primary education (P < 0.001) and a 15% increase was seen in those with secondary education (P < 0.001). The rate of increase in the prevalence of hypertension in the population with income level RM 3000-3999 was the highest (18%) during this period. In general, the older age group had higher prevalence of hypertension in the 2006 and 2011 NHMSs. The prevalence peaked at 74.1% among population aged 65 to 69 years in the 2011 NHMS. Both the proportion of awareness and the control of hypertension in Malaysia improved from 1996 to 2006. A change in the control of hypertension was 13% higher in women than in men.The findings suggest that the magnitude of hypertension in Malaysia needs additional attention. Strengthening the screening for hypertension in primary health-care settings in the high-risk groups and frequent health promotion to the community to enhance individual awareness and commitment to healthy living would be of immense value.

Prevalence of Hypertension in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

We aimed to obtain overall and regional estimates of hypertension prevalence, and to examine the pattern of this disease condition across different socio-demographic characteristics in low-and middle-income countries. We searched electronic databases from inception to August 2015. We included population-based studies that reported hypertension prevalence using the current definition of blood pressure ≥140/90 mm Hg or self-reported use of antihypertensive medication. We used random-effects meta-analyses to pool prevalence estimates of hypertension, overall, by World Bank region and country income group. Meta-regression analyses were performed to explore sources of heterogeneity across the included studies. A total of 242 studies, comprising data on 1,494,609 adults from 45 countries, met our inclusion criteria. The overall prevalence of hypertension was 32.3% (95% confidence interval [CI] 29.4-35.3), with the Latin America and Caribbean region reporting the highest estimates (39.1%, 95% CI 33.1-45.2). Pooled prevalence estimate was also highest across upper middle income countries (37.8%, 95% CI 35.0-40.6) and lowest across low-income countries (23.1%, 95% CI 20.1-26.2). Prevalence estimates were significantly higher in the elderly (≥65 years) compared with younger adults (<65 years) overall and across the geographical regions; however, there was no significant sex-difference in hypertension prevalence (31.9% vs 30.8%, P = 0.6). Persons without formal education (49.0% vs 24.9%, P < 0.00001), overweight/obese (46.4% vs 26.3%, P < 0.00001), and urban settlers (32.7% vs 25.2%, P = 0.0005) were also more likely to be hypertensive, compared with those who were educated, normal weight, and rural settlers respectively. This study provides contemporary and up-to-date estimates that reflect the significant burden of hypertension in low- and middle-income countries, as well as evidence that hypertension remains a major public health issue across the various socio-demographic subgroups. On average, about 1 in 3 adults in the developing world is hypertensive. The findings of this study will be useful for the design of hypertension screening and treatment programmes in low- and middle-income countries.

Prevalence of hypertension among federal ministry civil servants in Addis Ababa, Ethiopia: a call for a workplace-screening program

BACKGROUND

The prevalence of hypertension (HTN) is increasing rapidly in Ethiopia, but data are limited on hypertension prevalence in specific workplaces. Therefore, the aim of this study was to assess the prevalence and associated factors of hypertension among federal ministry civil servants.

METHODS

Institutional based cross sectional study was conducted from February to April 2014. Simple random sampling technique was used to select 655study participants. A standardized questionnaire adapted from The World Health Organization's (WHO) STEP tool was used to collect the data. In this study, HTN was defined as mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) of 140/90 mmHg and above, and patients on regular drug therapy for H. Data were entered into EPI-Info 3.5.2 and analyzed by SPSS version 20. Binary logistic regression model was used to identify associated factors. Odds ratio with 95 % CI was computed to assess the strength of the association and significant level.

RESULT

The prevalence of hypertension was found to be 27.3 % (95 % CI 23.3 - 31 %). Civil servants of age 48 years and above [AOR = 5.88, 95 % CI: 2.36-14.67], age 38-47 years [AOR = 2.80, 95 % CI: 1.18-6.60] and age 28-37 years [AOR = 2.35, 95 % CI: 1.00-5.56]) were more likely to be hypertensive. Similarly, ever cigarette smoking [AOR =2.34(1.31-4.17), family history of hypertension [AOR = 3.26, 95 % CI 1.96-5.40], self-reported Diabetes Mellitus (DM) [AOR = 13.56, 95 % CI: 6.91-26.6], and body mass index (BMI > 25 kg/m(2)) [AOR = 7.36, 95 % CI: 2.36-14.67] were found to be significantly associated with hypertension.

CONCLUSION

The prevalence of hypertension among federal ministry civil servants was found to be high; which is an indication for institution based hypertension-screening programs especially focusing on those aged 28 years and above, obese, DM patients and cigarette smokers.

Understanding the modifiable health systems barriers to hypertension management in Malaysia: a multi-method health systems appraisal approach

Background

The growing burden of non-communicable diseases in middle-income countries demands models of care that are appropriate to local contexts and acceptable to patients in order to be effective. We describe a multi-method health system appraisal to inform the design of an intervention that will be used in a cluster randomized controlled trial to improve hypertension control in Malaysia.

Methods

A health systems appraisal was undertaken in the capital, Kuala Lumpur, and poorer-resourced rural sites in Peninsular Malaysia and Sabah. Building on two systematic reviews of barriers to hypertension control, a conceptual framework was developed that guided analysis of survey data, documentary review and semi-structured interviews with key informants, health professionals and patients. The analysis followed the patients as they move through the health system, exploring the main modifiable system-level barriers to effective hypertension management, and seeking to explain obstacles to improved access and health outcomes.

Results

The study highlighted the need for the proposed intervention to take account of how Malaysian patients seek treatment in both the public and private sectors, and from western and various traditional practitioners, with many patients choosing to seek care across different services. Patients typically choose private care if they can afford to, while others attend heavily subsidised public clinics. Public hypertension clinics are often overwhelmed by numbers of patients attending, so health workers have little time to engage effectively with patients. Treatment adherence is poor, with a widespread belief, stemming from concepts of traditional medicine, that hypertension is a transient disturbance rather than a permanent asymptomatic condition. Drug supplies can be erratic in rural areas. Hypertension awareness and education material are limited, and what exist are poorly developed and ineffective.

Conclusion

Despite having a relatively well funded health system offering good access to care, Malaysia's health system still has significant barriers to effective hypertension management.

Discussion

The study uncovered major patient-related barriers to the detection and control of hypertension which will have an impact on the design and implementation of any hypertension intervention. Appropriate models of care must take account of the patient modifiable health systems barriers if they are to have any realistic chance of success; these findings are relevant to many countries seeking to effectively control hypertension despite resource constraints.

Perception of hypertension management by patients and doctors in Asia: potential to improve blood pressure control

BACKGROUND

Hypertension is one of the world's most common health conditions and is a leading risk factor for mortality. Although blood pressure can be modified, there is a large proportion of patients whose blood pressure remains uncontrolled. The aim of this study, termed Edvantage 360°, was to gain a deeper understanding of hypertension management in Asia from the perspective of patients and doctors, and to propose strategies to improve blood pressure control.

METHODS

Conducted in Hong Kong, Indonesia, Malaysia, the Philippines, South Korea, Taiwan, and Thailand, Edvantage 360° was a mixed-methods observational study that used both qualitative and quantitative elements: qualitative interviews and focus groups with patients (N = 110), quantitative interviews with patients (N = 709), and qualitative interviews with doctors (N = 85).

RESULTS

This study found that, although there is good understanding of the causes and consequences of hypertension among Asian patients, there is a lack of urgency to control blood pressure. Doctors and patients have different expectations of each other and a divergent view on what constitutes successful hypertension management. We also identified a fundamental gap between the beliefs of doctors and patients as to who should be most responsible for the patients' hypertension management. In addition, because patients find it difficult to comply with lifestyle modifications (often because of a decreased understanding of the changes required), adherence to medication regimens may be less of a limiting factor than doctors believe.

CONCLUSIONS

Doctors may provide better care by aligning with their patients on a common understanding of successful hypertension management. Doctors may also find it helpful to provide a more personalized explanation of any needed lifestyle modifications. The willingness of the doctor to adjust their patient interaction style to form a 'doctor-patient team' is important. In addition, we recommend that doctors should not attribute ineffectiveness of the treatment plan to patient non-adherence to medications, but rather adjust the medication regimen as needed.

National prevalence and associated risk factors of hypertension and prehypertension among Vietnamese adults

BACKGROUND

Hypertension has recently been identified as the leading risk factor for global mortality. This study aims to present the national prevalence of hypertension and prehypertension and, their determinants in Vietnamese adults.

METHODS

Nationally representative data were obtained from the National Adult Overweight Survey 2005. This one visit survey included 17,199 subjects aged 25-64 years, with a mean body mass index (BMI) of 20.7 kg/m(2).

RESULTS

The overall census-weighted JNC7 (the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) defined prevalence of hypertension was 20.7% (95% confidence interval (CI) = 19.4-22.1); the prevalence of prehypertension was 41.8% (95% CI = 40.4-43.1). Hypertension and prehypertension were more prevalent in men. Higher age, overweight, alcohol use (among men), and living in rural areas (among women) were independently associated with a higher prevalence of hypertension, whereas higher physical activity and education level were inversely associated. Age, BMI, and living in rural areas were independently associated with an increased prevalence of prehypertension. Among the hypertensives, 25.9% were aware of their hypertension, 12.2% were being treated, and 2.8% had their blood pressure under control; among the treated hypertensives, 32.4% had their blood pressure controlled.

CONCLUSIONS

Hypertension and prehypertension are prevalent in Vietnam, but awareness, treatment, and control are low. The findings suggest that lifestyle modifications, including the prevention of overweight, the promotion of physical activity particularly in urban areas, and the reduction of high alcohol consumption, may help to prevent hypertension in Vietnam. Furthermore, increased efforts regarding education, detection, and treatment could be important in management of hypertension and cardiovascular disease risk prevention.

Prevalence and determinants of cardiovascular disease risk factors among the residents of urban community housing projects in Malaysia

Objectives

The objectives are to assess the prevalence and determinants of cardiovascular disease (CVD) risk factors among the residents of Community Housing Projects in metropolitan Kuala Lumpur, Malaysia.

Method

By using simple random sampling, we selected and surveyed 833 households which comprised of 3,722 individuals. Out of the 2,360 adults, 50.5% participated in blood sampling and anthropometric measurement sessions. Uni and bivariate data analysis and multivariate binary logistic regression were applied to identify demographic and socioeconomic determinants of the existence of having at least one CVD risk factor.

Results

As a Result, while obesity (54.8%), hypercholesterolemia (51.5%), and hypertension (39.3%) were the most common CVD risk factors among the low-income respondents, smoking (16.3%), diabetes mellitus (7.8%) and alcohol consumption (1.4%) were the least prevalent. Finally, the results from the multivariate binary logistic model illustrated that compared to the Malays, the Indians were 41% less likely to have at least one of the CVD risk factors (OR = 0.59; 95% CI: 0.37 - 0.93).

Conclusion

In Conclusion, the low-income individuals were at higher risk of developing CVDs. Prospective policies addressing preventive actions and increased awareness focusing on low-income communities are highly recommended and to consider age, gender, ethnic backgrounds, and occupation classes.

Effects of established blood pressure loci on blood pressure values and hypertension risk in an Algerian population sample

Genome-wide association studies and subsequent replication studies have pinpointed 29 genetic variants associated with blood pressure (BP). None of these studies included North African populations. We therefore looked at whether or not these genetic variants modulated BP and hypertension (HTN) risk in an Algerian population sample. Twenty-nine single-nucleotide polymorphisms (SNPs) were genotyped in a representative sample of 787 subjects from the InSulino-résistance à ORan (ISOR) study (378 men and 409 women aged between 30 and 64 years and recruited from within the city of Oran, Algeria). Genetic variants were considered both individually and when combined as genetic predisposition scores (GPSs) for systolic BP (SBP), diastolic BP (DBP) and HTN risk. The SNPs in CYP1A1-ULK3, HFE and SH2B3 were significantly associated with BP and/or HTN. The SBP-GPS, DBP-GPS and HTN-GPS were associated with higher levels of DBP (+0.24 mm Hg P=0.05, +0.23 mm Hg P = 0.05 and +0.26 mm Hg P = 0.03, respectively). Moreover, the three GPSs tended to be associated with a 6% higher risk of HTN. Our study is the first to show that some of the BP loci validated in subjects of European descent were associated (either individually or when combined as GPSs) with BP traits and/or the HTN risk in an Algerian population, but to a lesser extent than in European populations. Although larger studies and meta-analyses of North African populations are needed to confirm the present results, our data contribute to a better understanding of genetic susceptibility to HTN.

Socio-demographic and psychosocial correlates of erectile dysfunction among hypertensive patients

OBJECTIVE

The main aim of the study was to estimate the prevalence of ED and the associated socio-demographic and psychological correlates among hypertensive patients from a rural multiethnic community in Malaysia.

METHODS

A cross-sectional study was conducted among hypertensive patients attending rural primary care clinics. The socio-demographic, health characteristics, erectile function and levels of depression, anxiety and stress were recorded and analysed. The International Index of ErectileFunction-5 (IIEF-5) questionnaire and the Depression, Anxiety and Stress Scale (DASS-21) were used to assess erectile function and the levels of depression, anxiety and stress, respectively.

RESULTS

A total of 253 hypertensive patients comprising 178 (70.4%) Malays, 56 (22.1%) Chinese and 18 (7.5%) Indians participated. The mean age of participants was 59.8 ± 10.62 years. Overall, the prevalence rate of ED was 62%: 90 (35%) with moderate and 69 (27%) with severe ED. The prevalence rate of ED among those aged 65 years or older (83.1%) was significantly higher than those less than 65 years (51.8%), (p<0.001). Higher prevalence rates were also noted among the Chinese (78.6%) compared to Malays (59.6%) and Indians (50%) (p=0.021); lower education level (69.1%) (p=0.026), among hypertensive patients with concomitant diabetes mellitus (70.6%) (p=0.026) and WHR ≥ 0.9 (31.3%) (p=0.021). However, no significant association was found between depression, anxiety and stress scores with IIEF-5 score.

CONCLUSION

The prevalence rate of ED among Malaysian hypertensive patients is high. The rate increases significantly with age, Chinese ethnicity, concomitant diabetes mellitus, lower education level, WHR and the number of pack years of smoking. ED should be properly recognized and managed in hypertensive patients.