Introduction: Hypertension is one of the most important risk factors for cardiovascular disease in Malaysia. The prevalence of hypertension nearly doubled over a ten-year period (1986 – 1996). This has resulted in a significant rise in its attendant cost. We aim to review the institutional anti-hypertensive use, the cost incurred and the implications on management in our local setting. Materials and Methods: A retrospective review of the annual cost (2006) of anti-hypertensive medications was undertaken at the Department of Pharmacy, Hospital Tengku Ampuan Afzan, a 600-bed major regional hospital on the east-coast of Malaysia. The total number of prescriptions given out and the total cost per drug is then factored to give the annual cost per drug per person in a percentage of the total annual expenditure.Results: The majority of patients were on either 2 (46.5%) or 3 (25.9%) anti-hypertensives. The most frequently prescribed medications were ACE Inhibitors (33.45%), Calcium channel blockers (29.63%), diuretics (16.67%) and β-blockers (13.64%). In terms of cost however, the Calcium channel blockers constituted the greatest percentage of the annual anti-hypertensive budget (63.67%) compared to ACE Inhibitors at just 20.04% of the annual expenditure. The least costly group of drugs is the diuretic making up 16.67% of the total annual prescriptions but only constituting 1.23% of the annual cost. Conclusion: The majority of patients were on ACE Inhibitors and/or Calcium channel blockers. This has huge monetary implications as they represent a large proportion of the annual antihypertensive allocation. There may be a need to reverse the trend in the developing world due to cost restrictions.
Hypertension is the most prevalent risk factor of cardiovascular diseases in Malaysia. 17.3% of hypertension cases in Malaysia is attributed to adults aged 18 to 39 years. Psychosocial distress is a possible risk factor for elevated blood pressure in young adults, and cortisol could be the mediating factor. The aim of this study is to evaluate the mediating role of cortisol in hypertension and psychosocial distress in young adults. Methods and materials:A comparative cross-sectional study was conducted in 240 young adults aged 18 to 45 years. The body mass index, waist circumference and blood pressure parameters were recorded. Serum cortisol, creatinine, fasting blood glucose and lipid profile were measured following acute mental stress test. Psychosocial distress was assessed using the DASS-21 questionnaire. Results:Mean (standard deviation) values for SBP, DBP, MAP were 126.0(16.3), 84.1(12.2) and 98.1(13.1) mmHg respectively. Anxiety was significantly associated with systolic blood pressure (β=0.644), diastolic blood pressure (β=0.454) and mean arterial pressure (β=0.516) after adjusting for sex, age and cortisol. However, it was not mediated by cortisol. Depression and stress were not found to have any effect on blood pressure of the young adults studied. Conclusion:The data suggest that there is no elevated risk for psychosocial distress and hypertension that cortisol poses in young adults.
The prevalence of hypertension in Malaysia is alarmingly high. The National Survey in 2006 showed 43% of people aged ≥30 had hypertension and among treated patients, only 26% reached the target blood pressure (BP) of <140/90 mmHg. We evaluated BP control in tertiary institutions in Malaysia and the difference in hypertension control between genders and within specific cardiovascular risk factor groups. This cross-sectional study aimed at determining BP control among hypertensive patients attending three specialist institutions in Malaysia, located in Kuala Lumpur, Kuantan and Kota Bharu. A total of 950 patients with known hypertension for at least 6 months were recruited between January 2007 and July 2008. There were more males (n=548, 57.7%) with a mean age of 60.3±10.5 (±s.d.) years. The mean systolic BP (SBP) and diastolic BP were 138.8±20.3 mmHg and 79.6±11.3 mmHg, respectively. In total, 48.5% of all the patients had good BP control (<140/90 mmHg). Males had better SBP control compared with female (SBP: 135.9±18.7 vs. 142.8±21.7 mmHg, P<0.001). Overall, 54.6% of the patients had ischemic heart disease (IHD), 24.2% had undergone coronary revascularization, 50.1% were diabetic, 68.6% hyperlipidemic, 17.3% smokers and 27.5% had renal impairment. Males and small numbers of antihypertensives used were independently associated with better treatment outcome. In summary, our data reveal a poorer BP control, secondary to higher SBP levels in women. Moreover, the gender difference is more pronounced in patients with concomitant diabetes mellitus, renal impairment and IHD.
Three hundred thirty-one consecutive patients presenting with hypertension to the outpatient medical clinic of Tengku Ampuan Afzan Hospital, Kuantan, Malaysia were screened and 150 patients with concurrent diabetes were enrolled into a cross-sectional study. The majority of patients were male (60.6%) with a mean age of 60.0 +/- 11.0 years. The mean systolic blood pressure (SBP) was 140.9 +/- 20.1 mmHg and the mean diastolic blood pressure (DBP) was 81.7 +/- 9.8 mmHg. Only 38.0% (57/150) of patients had blood pressures within recommended guidelines (130/80 mmHg). The mean blood pressure in this group was 123.7 +/- 8.5/76.4 +/- 5.6 mmHg. The majority of patients were on either 2 (41.3%) or 3 (31.3%) anti-hypertensives. Females had a significantly higher SBP 145.4 +/- 22.7 vs. 138.0 +/- 17.8 mmHg in males (p = 0.026). The level of blood pressure control in diabetics was unsatisfactory, especially in females and the elderly. A reassessment of priorities in the management of patients with concurrent hypertension and diabetes is therefore, urgently needed.
Study site: outpatient medical clinic of Tengku Ampuan Afzan Hospital,